Provider Demographics
NPI:1619407046
Name:HOLSEY, EDWIND ALLEN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:EDWIND
Middle Name:ALLEN
Last Name:HOLSEY
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:MR
Other - First Name:ALLEN
Other - Middle Name:
Other - Last Name:HOLSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:908 UNION ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2897
Mailing Address - Country:US
Mailing Address - Phone:517-945-8117
Mailing Address - Fax:517-945-8117
Practice Address - Street 1:908 UNION ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2897
Practice Address - Country:US
Practice Address - Phone:517-945-8117
Practice Address - Fax:517-945-8117
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL664924225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist