Provider Demographics
NPI:1245440981
Name:HOLESTINE, LINDA (LMP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:HOLESTINE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 E CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1981
Mailing Address - Country:US
Mailing Address - Phone:509-947-0833
Mailing Address - Fax:541-567-6747
Practice Address - Street 1:313 N MORAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2625
Practice Address - Country:US
Practice Address - Phone:509-947-0833
Practice Address - Fax:541-567-6747
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013835225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist