Provider Demographics
NPI:1518214907
Name:HOLST, BRIE LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRIE
Middle Name:LYNN
Last Name:HOLST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GLENWOOD ST STE 111
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4014
Mailing Address - Country:US
Mailing Address - Phone:913-831-2721
Mailing Address - Fax:913-384-0127
Practice Address - Street 1:6400 GLENWOOD ST STE 111
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4014
Practice Address - Country:US
Practice Address - Phone:913-831-2721
Practice Address - Fax:913-384-0127
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402399225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant