Provider Demographics
NPI:1548448947
Name:HOLLIDAY, AMANDA LEIGH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:LEIGH
Other - Last Name:HOLLIDAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10141 NE 64TH ST
Mailing Address - Street 2:APT. B
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6819
Mailing Address - Country:US
Mailing Address - Phone:509-860-0531
Mailing Address - Fax:
Practice Address - Street 1:1175 NW GILMAN BLVD
Practice Address - Street 2:STE B-5
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5399
Practice Address - Country:US
Practice Address - Phone:425-313-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist