Provider Demographics
NPI:1598858318
Name:HOLLEY, KIM THERESA (LMT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:THERESA
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 1:280 W KAGY BLVD
Mailing Address - Street 2:SUITE D, #275
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6056
Mailing Address - Country:US
Mailing Address - Phone:406-551-3536
Mailing Address - Fax:
Practice Address - Street 1:280 W KAGY BLVD
Practice Address - Street 2:SUITE D, #275
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6056
Practice Address - Country:US
Practice Address - Phone:406-551-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-6182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist