Provider Demographics
NPI:1386037869
Name:HOLBROOK, VICKIE
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICKIE
Other - Middle Name:
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:326 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449
Mailing Address - Country:US
Mailing Address - Phone:318-256-0660
Mailing Address - Fax:318-256-0661
Practice Address - Street 1:326 FISHER RD
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449
Practice Address - Country:US
Practice Address - Phone:318-256-0660
Practice Address - Fax:318-256-0661
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0053225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist