Provider Demographics
NPI:1457411852
Name:HOLCOMBE, MICHELLE LORAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LORAINE
Last Name:HOLCOMBE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LORAINE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:47 HUNTRESS DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1284
Mailing Address - Country:US
Mailing Address - Phone:864-363-3090
Mailing Address - Fax:864-271-4487
Practice Address - Street 1:319 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4021
Practice Address - Country:US
Practice Address - Phone:864-233-1153
Practice Address - Fax:864-271-4487
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist