Provider Demographics
NPI:1376797050
Name:HOLLADAY, MEREDITH L (LMT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1664
Mailing Address - Country:US
Mailing Address - Phone:206-714-9751
Mailing Address - Fax:
Practice Address - Street 1:1419 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2105
Practice Address - Country:US
Practice Address - Phone:206-838-8480
Practice Address - Fax:206-838-8481
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG013235172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist