Provider Demographics
NPI:1417399668
Name:HOLT, THOMAS P (LMP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:HOLT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34113 SE DAVID POWELL RD
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-8801
Mailing Address - Country:US
Mailing Address - Phone:425-985-1822
Mailing Address - Fax:
Practice Address - Street 1:7726 CENTER BLVD SE STE 125
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-8751
Practice Address - Country:US
Practice Address - Phone:425-396-0613
Practice Address - Fax:425-396-0614
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60364709174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist