Provider Demographics
NPI:1467637272
Name:HOLLEY, ANDRIA S (LMT)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:S
Last Name:HOLLEY
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 1:15521 183RD PL NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-9319
Mailing Address - Country:US
Mailing Address - Phone:425-890-5018
Mailing Address - Fax:
Practice Address - Street 1:8060 165TH AVE NE STE 210
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3981
Practice Address - Country:US
Practice Address - Phone:425-890-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022171225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist