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General NPI Number Information
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NPI Number | 1235884180
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Entity Type | Individual
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Provider Name | MATTHEW IAN HOLBROOK LPA
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Gender | Male
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 10100 LINN STATION RD STE 1A
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City | LOUISVILLE
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State | KY
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Zip | 40223-3861
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Country | US
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Telephone | 502-909-0772
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Fax | 855-859-0123
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Provider Business Mailing Address
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Address Line | 12300 PLANTSIDE DR
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City | LOUISVILLE
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State | KY
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Zip | 40299-6345
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Country | US
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Telephone | 502-909-0772
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2279P1005X
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Taxonomy Name | Pulmonary Rehabilitation Registered Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 293310
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License Number State | KY
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