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General NPI Number Information
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NPI Number | 1093318875
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Entity Type | Individual
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Provider Name | VIRJEANA HOLBROOK
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 945 W RUSSELL ST
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City | ELKHORN CITY
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State | KY
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Zip | 41522-9032
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Country | US
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Telephone | 606-754-4134
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Fax |
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Provider Business Mailing Address
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Address Line | 92 OLD 119 LOOP
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City | JENKINS
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State | KY
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Zip | 41537-8808
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Country | US
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Telephone | 276-639-6495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A02438
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License Number State | KY
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