Healthcare Provider Details

I. General information

NPI: 1326326554
Provider Name (Legal Business Name): ANNA BROOKS CHURM HOLCOMB DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/13/2022
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W WILLIAMS ST
APEX NC
27502-5201
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 919-636-1957
  • Fax:
Mailing address:
  • Phone: 919-220-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP17063
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP17063
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICAL LICENSE
# 2
IdentifierPT010362
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerGA PT LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: