Provider Demographics
NPI:1851686406
Name:FREEMAN, HOLLY CAROL (CMT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CAROL
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1911
Mailing Address - Country:US
Mailing Address - Phone:208-550-1185
Mailing Address - Fax:
Practice Address - Street 1:25 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-1911
Practice Address - Country:US
Practice Address - Phone:208-550-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist