NPIMap

Individual provider Active NPI

Brent Andrew Holcomb, DPT

  • Physical Therapist
  • Marengo, IL
National Provider Identifier
1134474687
Registry record updated Jul 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070018989 Issued in IL
Practice address
212 Lindow LN
Suite M
Marengo, IL 60152-9480
Phone
(815) 568-8878
Fax
(815) 568-9977
NPI assigned
Jul 20, 2012
Last updated
Jul 20, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070018989 IL Primary

Addresses

Primary practice location

212 Lindow LN
Suite M
Marengo, IL 60152-9480

Mailing address

212 Lindow LN
Suite M
Marengo, IL 60152-9480
Phone (815) 568-8878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Marengo Physical Therapy, Inc. Past Accepting new patients
Marengo Physical Therapy, Inc. Physical Therapist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342742400000",
    "number": "1134474687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 LINDOW LN",
            "address_2": "SUITE M",
            "city": "MARENGO",
            "state": "IL",
            "postal_code": "601529480",
            "telephone_number": "815-568-8878",
            "fax_number": "815-568-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 LINDOW LN",
            "address_2": "SUITE M",
            "city": "MARENGO",
            "state": "IL",
            "postal_code": "601529480",
            "telephone_number": "815-568-8878",
            "fax_number": "815-568-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLCOMB",
        "first_name": "BRENT",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-20",
        "last_updated": "2012-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070018989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marengo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.