Provider Demographics
NPI:1144610817
Name:HOLLIDAY, JOSHUA (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SOUTHERN AVE
Mailing Address - Street 2:3-H
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1684
Mailing Address - Country:US
Mailing Address - Phone:360-509-8983
Mailing Address - Fax:
Practice Address - Street 1:605 SOUTHERN AVE
Practice Address - Street 2:3-H
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1684
Practice Address - Country:US
Practice Address - Phone:360-509-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1 603617202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer