Provider Demographics
NPI:1578363081
Name:HOLMES, CHASTITY SIERRA
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:SIERRA
Last Name:HOLMES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 29TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4589
Mailing Address - Country:US
Mailing Address - Phone:320-240-0300
Mailing Address - Fax:320-240-0303
Practice Address - Street 1:48 29TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4589
Practice Address - Country:US
Practice Address - Phone:320-240-0300
Practice Address - Fax:320-240-0303
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist