Provider Demographics
NPI:1841039377
Name:HOLMBO, JOSHUA MICHAEL THOMAS (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MICHAEL THOMAS
Last Name:HOLMBO
Suffix:
Gender:M
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:HOLMBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICENSED MASSAGE THE
Mailing Address - Street 1:4891 SW MCVEY AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:541-239-4373
Mailing Address - Fax:
Practice Address - Street 1:4891 SW MCVEY AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-239-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist