Provider Demographics
NPI:1972172955
Name:HOLBROOK, LISA MARIE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:116 EAST AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2300
Mailing Address - Country:US
Mailing Address - Phone:330-696-5999
Mailing Address - Fax:
Practice Address - Street 1:116 EAST AVE STE 2B
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2300
Practice Address - Country:US
Practice Address - Phone:330-696-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-017563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist