Provider Demographics
NPI:1881412443
Name:HOLBROOK, COREY GRACE (LMT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:GRACE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:GRACE
Other - Last Name:MAJEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1220 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2909
Mailing Address - Country:US
Mailing Address - Phone:218-233-1188
Mailing Address - Fax:218-287-1829
Practice Address - Street 1:1220 2ND AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2909
Practice Address - Country:US
Practice Address - Phone:218-233-1188
Practice Address - Fax:218-287-1829
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24-0814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist