Provider Demographics
NPI:1407094360
Name:ROSS, HOLLY J (LIC AC, LMT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:ROSS
Suffix:
Gender:F
Credentials:LIC AC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50773
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0996
Mailing Address - Country:US
Mailing Address - Phone:303-725-1850
Mailing Address - Fax:
Practice Address - Street 1:895 COUNTRY CLUB RD
Practice Address - Street 2:A-140
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6003
Practice Address - Country:US
Practice Address - Phone:541-484-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO545171100000X
OR22247225700000X
ORAC178265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist