Provider Demographics
NPI:1275271298
Name:HOLT, ASHLEY NICOLLE (CMT)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:NICOLLE
Last Name:HOLT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:NICOLLE
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NICOLLE
Mailing Address - Street 1:4859 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3413
Mailing Address - Country:US
Mailing Address - Phone:831-801-7579
Mailing Address - Fax:
Practice Address - Street 1:4859 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3413
Practice Address - Country:US
Practice Address - Phone:831-801-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty