Provider Demographics
NPI:1952684136
Name:MASTEN, HOLLIE ANN (LMT)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:ANN
Last Name:MASTEN
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 1:704 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1035
Mailing Address - Country:US
Mailing Address - Phone:302-249-0133
Mailing Address - Fax:
Practice Address - Street 1:704 N SHORE DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1035
Practice Address - Country:US
Practice Address - Phone:302-249-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0000898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist