Provider Demographics
NPI:1093327520
Name:HOLLAND, BRONSON (LMT)
Entity Type:Individual
Prefix:
First Name:BRONSON
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 CONNERY RD
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-8906
Mailing Address - Country:US
Mailing Address - Phone:509-741-0087
Mailing Address - Fax:
Practice Address - Street 1:100 EASTMONT AVE STE B2
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7706
Practice Address - Country:US
Practice Address - Phone:509-741-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61093415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist