Provider Demographics
NPI:1780725515
Name:TOWKANIUK, HOLLY K (CMT, HHP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:K
Last Name:TOWKANIUK
Suffix:
Gender:F
Credentials:CMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 GARRETT CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8660
Mailing Address - Country:US
Mailing Address - Phone:209-814-7323
Mailing Address - Fax:
Practice Address - Street 1:95 W 11TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3960
Practice Address - Country:US
Practice Address - Phone:209-814-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
CA4524172M00000X, 173C00000X, 225700000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator