Provider Demographics
NPI:1225172737
Name:HOLZKNECHT, BRENDA M (LMP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:HOLZKNECHT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 198TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7059
Mailing Address - Country:US
Mailing Address - Phone:425-640-2850
Mailing Address - Fax:
Practice Address - Street 1:17917 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6384
Practice Address - Country:US
Practice Address - Phone:425-483-5594
Practice Address - Fax:425-487-0727
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009626225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist