Provider Demographics
NPI:1053806091
Name:HOLLEY, MARGARET ROSE (DN, LMT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:DN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 CAMINO CHUECO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5261
Mailing Address - Country:US
Mailing Address - Phone:505-235-5997
Mailing Address - Fax:
Practice Address - Street 1:2599 CAMINO CHUECO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5261
Practice Address - Country:US
Practice Address - Phone:505-235-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7334225700000X
NM01038172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty