Provider Demographics
NPI:1295421980
Name:HOLLAND, BROOKE (CMT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W ISLAY ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2695
Mailing Address - Country:US
Mailing Address - Phone:319-351-0977
Mailing Address - Fax:
Practice Address - Street 1:211 E ANAPAMU ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2005
Practice Address - Country:US
Practice Address - Phone:310-351-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65984225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist