Provider Demographics
NPI:1649462177
Name:HOLBROOK, JAMES DAVID (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3625
Mailing Address - Country:US
Mailing Address - Phone:601-849-9882
Mailing Address - Fax:601-849-9871
Practice Address - Street 1:301 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3625
Practice Address - Country:US
Practice Address - Phone:601-849-9882
Practice Address - Fax:601-849-9871
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist