Provider Demographics
NPI:1457739153
Name:HOLT, LINDSAY (LMP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:HOLT
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 1:21311 NE 189TH ST
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9750
Mailing Address - Country:US
Mailing Address - Phone:360-882-8952
Mailing Address - Fax:
Practice Address - Street 1:15814 NE 182ND AVE
Practice Address - Street 2:UNIT C
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-9701
Practice Address - Country:US
Practice Address - Phone:360-433-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021539225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist