Provider Demographics
NPI:1841308780
Name:DANIEL, HOLLY LOUISE (PT, LAC)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LOUISE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4079
Mailing Address - Country:US
Mailing Address - Phone:360-461-4102
Mailing Address - Fax:360-683-5974
Practice Address - Street 1:127 W BELL ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3752
Practice Address - Country:US
Practice Address - Phone:360-461-4102
Practice Address - Fax:360-683-5974
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000404171100000X
WAPT00006149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7000014OtherAETNA
WAREGENCE BLUE SHIELDOther8111DA
WA168776OtherSTATE LABOR AND INDUSTIES
WAREGENCE BLUE SHIELDOther9116DA
WA7613420OtherAETNA