Provider Demographics
NPI:1912032525
Name:HOLST, KATHLEEN JOAN (NCTMB)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JOAN
Last Name:HOLST
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TWELVE OAKS CENTER DR
Mailing Address - Street 2:SUITE 813
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4601
Mailing Address - Country:US
Mailing Address - Phone:952-475-2508
Mailing Address - Fax:
Practice Address - Street 1:801 TWELVE OAKS CENTER DR
Practice Address - Street 2:SUITE 813
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4601
Practice Address - Country:US
Practice Address - Phone:952-475-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist