Provider Demographics
NPI:1487974986
Name:HOLTEN, DANIELLE JEAN (LMT, OMT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JEAN
Last Name:HOLTEN
Suffix:
Gender:F
Credentials:LMT, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 109TH AVE NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3846
Mailing Address - Country:US
Mailing Address - Phone:763-528-8557
Mailing Address - Fax:
Practice Address - Street 1:1061 109TH AVE NE
Practice Address - Street 2:SUITE D
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3846
Practice Address - Country:US
Practice Address - Phone:763-528-8557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2010-00109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist