Provider Demographics
NPI:1235884180
Name:HOLBROOK, MATTHEW IAN (LPA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:IAN
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 PLANTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6345
Mailing Address - Country:US
Mailing Address - Phone:502-909-0772
Mailing Address - Fax:
Practice Address - Street 1:10100 LINN STATION RD STE 1A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3861
Practice Address - Country:US
Practice Address - Phone:502-909-0772
Practice Address - Fax:855-859-0123
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 2279P1005X
KY293310103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation