Provider Demographics
NPI:1811435274
Name:HOLDERBACH, SIMONE (LMP/NKT)
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:
Last Name:HOLDERBACH
Suffix:
Gender:F
Credentials:LMP/NKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13235 NE 202ND CT
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8709
Mailing Address - Country:US
Mailing Address - Phone:425-949-5011
Mailing Address - Fax:
Practice Address - Street 1:11417 124TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4677
Practice Address - Country:US
Practice Address - Phone:425-236-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60486695225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist