Provider Demographics
NPI:1891074571
Name:HUGHES, HOLLY KATHRYN (LMT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:KATHRYN
Last Name:HUGHES
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 1:10321 BELLAIR RD
Mailing Address - Street 2:
Mailing Address - City:PILOT GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65276-2827
Mailing Address - Country:US
Mailing Address - Phone:660-834-4092
Mailing Address - Fax:
Practice Address - Street 1:10321 BELLAIR RD
Practice Address - Street 2:
Practice Address - City:PILOT GROVE
Practice Address - State:MO
Practice Address - Zip Code:65276-2827
Practice Address - Country:US
Practice Address - Phone:660-834-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006017348OtherMISSOURI BOARD OF THERAPEUTIC MASSAGE
MO742906OtherABMP
MO53029007OtherNCBMT