Provider Demographics
NPI:1316710791
Name:HOLMES, LUKE TIMOTHY (LMT)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:TIMOTHY
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 W WASHINGTON AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-2518
Mailing Address - Country:US
Mailing Address - Phone:509-902-1222
Mailing Address - Fax:
Practice Address - Street 1:2405 W WASHINGTON AVE STE 140
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-2518
Practice Address - Country:US
Practice Address - Phone:509-902-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61500917225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist