Individual
MR. CODY HOLLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5600 PACIFIC AVE SE, LACEY, WA 98503-1258
(360) 493-2000
Mailing address
515 4TH AVE SW, TUMWATER, WA 98512-6522
(360) 485-6865
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60813390
WA
Other
Enumeration date
03/05/2018
Last updated
01/22/2019
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