Provider Demographics
NPI:1376354241
Name:HOLMES, DWAYNE (LMT)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
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 1:10839 N CENTRAL EXPY APT 2143
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2110
Mailing Address - Country:US
Mailing Address - Phone:214-497-7183
Mailing Address - Fax:
Practice Address - Street 1:10839 N CENTRAL EXPY APT 2143
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2110
Practice Address - Country:US
Practice Address - Phone:214-497-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT143604225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist