Provider Demographics
NPI:1134474687
Name:HOLCOMB, BRENT ANDREW (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ANDREW
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 LINDOW LN
Mailing Address - Street 2:SUITE M
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-9480
Mailing Address - Country:US
Mailing Address - Phone:815-568-8878
Mailing Address - Fax:815-568-9977
Practice Address - Street 1:212 LINDOW LN
Practice Address - Street 2:SUITE M
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-9480
Practice Address - Country:US
Practice Address - Phone:815-568-8878
Practice Address - Fax:815-568-9977
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist