Provider Demographics
NPI:1073746798
Name:BOULDER HEALTH AND RACQUET CLUB
Entity Type:Organization
Organization Name:BOULDER HEALTH AND RACQUET CLUB
Other - Org Name:RALLYSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDAMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-449-4800
Mailing Address - Street 1:2727 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1201
Mailing Address - Country:US
Mailing Address - Phone:303-449-4800
Mailing Address - Fax:
Practice Address - Street 1:2727 29TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1201
Practice Address - Country:US
Practice Address - Phone:303-449-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2255A2300X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty