Provider Demographics
NPI:1649386426
Name:SURBER, HOLLY E (PT)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:E
Last Name:SURBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:E
Other - Last Name:DEVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:605 OLD BALLAS RD STE 128
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7070
Mailing Address - Country:US
Mailing Address - Phone:314-801-8775
Mailing Address - Fax:
Practice Address - Street 1:605 OLD BALLAS RD STE 128
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7070
Practice Address - Country:US
Practice Address - Phone:314-801-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999137493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist