Provider Demographics
NPI:1275922486
Name:HOLBROOK, JENNIFER CLAIRE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6068 GRANTS FERRY RD
Mailing Address - Street 2:NONE
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8137
Mailing Address - Country:US
Mailing Address - Phone:337-577-0808
Mailing Address - Fax:
Practice Address - Street 1:151 E METRO DR STE 106
Practice Address - Street 2:NONE
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-4403
Practice Address - Country:US
Practice Address - Phone:337-577-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT06402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer