Provider Demographics
NPI:1932688645
Name:HOLBROOK, NICHOLAS (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9654
Mailing Address - Country:US
Mailing Address - Phone:269-275-5376
Mailing Address - Fax:
Practice Address - Street 1:360 EAST BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48825
Practice Address - Country:US
Practice Address - Phone:269-275-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer