Provider Demographics
NPI:1023104148
Name:HOLBROOK, EILEEN (PT)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 ARTESIA BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4065
Mailing Address - Country:US
Mailing Address - Phone:562-402-8389
Mailing Address - Fax:562-403-2638
Practice Address - Street 1:11911 ARTESIA BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90701-4065
Practice Address - Country:US
Practice Address - Phone:562-402-8389
Practice Address - Fax:562-403-2638
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT10904Medicare ID - Type Unspecified