Provider Demographics
NPI:1760938690
Name:IRWIN, HOLLY ROSEMARY (LMT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ROSEMARY
Last Name:IRWIN
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:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0915
Mailing Address - Country:US
Mailing Address - Phone:907-314-3049
Mailing Address - Fax:
Practice Address - Street 1:251 BATTLE RD
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-0915
Practice Address - Country:US
Practice Address - Phone:907-314-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104423225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK104423OtherSTATE OF ALASKA