Provider Demographics
NPI:1558880534
Name:HOLCOMB, WHITNI RAE (DPT)
Entity Type:Individual
Prefix:
First Name:WHITNI
Middle Name:RAE
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:WHITNI
Other - Middle Name:RAE
Other - Last Name:LUECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6501 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-6102
Mailing Address - Country:US
Mailing Address - Phone:817-370-9891
Mailing Address - Fax:
Practice Address - Street 1:3803 E US HIGHWAY 377 UNIT 200
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7429
Practice Address - Country:US
Practice Address - Phone:682-260-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1295502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist