Provider Demographics
NPI:1992541338
Name:HOLCOMB, JOSHUA MACK (PT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MACK
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JOSH
Other - Middle Name:MACK
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:
Practice Address - Street 1:1107 NE 45TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4631
Practice Address - Country:US
Practice Address - Phone:206-545-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303123225100000X
WAPT61578738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501303123OtherDEPARTMENT OF LICENSING AND REGULATORY AFFAIRS