Provider Demographics
NPI:1013242247
Name:HOLLOWAY, BRIAN JAMISON (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMISON
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 ORCHARD LN APT N
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-5709
Mailing Address - Country:US
Mailing Address - Phone:386-299-1280
Mailing Address - Fax:
Practice Address - Street 1:1893 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5535
Practice Address - Country:US
Practice Address - Phone:386-676-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist