Provider Demographics
NPI:1285958629
Name:ANDREAS, HOLLY W (LMT)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:W
Last Name:ANDREAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 JICAMA WAY SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2185
Mailing Address - Country:US
Mailing Address - Phone:505-888-4651
Mailing Address - Fax:
Practice Address - Street 1:10820 JICAMA WAY SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2185
Practice Address - Country:US
Practice Address - Phone:505-888-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist