Provider Demographics
NPI:1164972469
Name:HOLEMAN, ANNA (LMT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HOLEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:119 N STONE RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1042
Mailing Address - Country:US
Mailing Address - Phone:231-924-2590
Mailing Address - Fax:231-924-6560
Practice Address - Street 1:119 N STONE RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1042
Practice Address - Country:US
Practice Address - Phone:231-924-2590
Practice Address - Fax:231-924-6560
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist