Healthcare Provider Details

I. General information

NPI: 1811332612
Provider Name (Legal Business Name): BROOK HOLMES PT, DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 PORT WASHINGTON RD SUITE 210
GRAFTON WI
53024-9201
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-329-2700
  • Fax: 262-329-2701
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5175
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5175-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: