Provider Demographics
NPI:1518070655
Name:TANNER, HOLLY C (MA, PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:C
Last Name:TANNER
Suffix:
Gender:F
Credentials:MA, PT
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Mailing Address - Street 1:3417 EVANSTON AVE N
Mailing Address - Street 2:SUITE 229
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8626
Mailing Address - Country:US
Mailing Address - Phone:206-858-2914
Mailing Address - Fax:206-732-6544
Practice Address - Street 1:3417 EVANSTON AVE N
Practice Address - Street 2:SUITE 229
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8626
Practice Address - Country:US
Practice Address - Phone:206-858-2914
Practice Address - Fax:206-732-6544
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-09-02
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Provider Licenses
StateLicense IDTaxonomies
MN5549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA650017399OtherRAILROAD MEDICARE
WA133463OtherDEPT OF LABOR & INDUSTRIE
WA8332678Medicaid
WA8924971OtherCRIME VICTIMS
WAA006OtherTRICARE
WATA8702OtherREGENCE BLUE SHIELD
WA8332678Medicaid