Provider Demographics
NPI:1235247636
Name:HOLYCROSS, KIRSTEN MARIE (NCBTMB, LMT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MARIE
Last Name:HOLYCROSS
Suffix:
Gender:F
Credentials:NCBTMB, LMT
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:119 1/2 E CALLENDER ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2613
Mailing Address - Country:US
Mailing Address - Phone:406-222-2891
Mailing Address - Fax:
Practice Address - Street 1:712 N D ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2111
Practice Address - Country:US
Practice Address - Phone:406-222-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT306534-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist