Active NPI
Brent Charles Holtgrewe, MS., BSC., LAT, ATC
- Athletic Trainer
- Florissant, MO
National Provider Identifier
1720266216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2016022071
- Practice address
- 209 Rue Saint Louis
Florissant, MO 63031-5025 - Phone
- (314) 596-2656
- NPI assigned
- Feb 6, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL1968 | FL | |
| Athletic Trainer | 2255A2300X | 2016022071 | MO | Primary |
Addresses
Primary practice location
209 Rue Saint Louis
Florissant, MO 63031-5025
Mailing address
209 Rue Saint Louis
Florissant, MO 63031-5025
Phone (314) 596-2656
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL1968 | FL | MD | Athletic Trainer |
| 2016022071 | MO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693872000000",
"number": "1720266216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 RUE SAINT LOUIS",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630315025",
"telephone_number": "314-596-2656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 RUE SAINT LOUIS",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630315025",
"telephone_number": "314-596-2656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLTGREWE",
"first_name": "BRENT",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "MS., BSC., LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-06",
"last_updated": "2023-09-05",
"certification_date": "2023-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL1968",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MO",
"license": "2016022071",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.