Provider Demographics
NPI:1114323714
Name:HIGH GEAR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HIGH GEAR PHYSICAL THERAPY
Other - Org Name:HOLBROOK INTEGRATIVE MANUAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:434-282-5361
Mailing Address - Street 1:2015B WOODBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1148
Mailing Address - Country:US
Mailing Address - Phone:434-282-5361
Mailing Address - Fax:434-202-5955
Practice Address - Street 1:2015B WOODBROOK CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1148
Practice Address - Country:US
Practice Address - Phone:434-282-5361
Practice Address - Fax:434-202-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052078822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty