Provider Demographics
NPI:1396084778
Name:HOLBROOK, CAREY (PTA)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9555
Mailing Address - Country:US
Mailing Address - Phone:419-935-7030
Mailing Address - Fax:419-935-7030
Practice Address - Street 1:2554 MILLER RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9555
Practice Address - Country:US
Practice Address - Phone:419-935-7030
Practice Address - Fax:419-935-7030
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-04368225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant