Provider Demographics
NPI:1659562551
Name:HOLBOURN INTEGRATED THERAPY LLC
Entity type:Organization
Organization Name:HOLBOURN INTEGRATED THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:901-272-2822
Mailing Address - Street 1:612 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5351
Mailing Address - Country:US
Mailing Address - Phone:901-272-2822
Mailing Address - Fax:901-272-2823
Practice Address - Street 1:612 S COOPER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5351
Practice Address - Country:US
Practice Address - Phone:901-272-2822
Practice Address - Fax:901-272-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729247Medicaid
TN3729247Medicare PIN