Provider Demographics
NPI:1245730597
Name:HOLISTIC PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:HOLISTIC PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-993-9767
Mailing Address - Street 1:6650 W 44TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4711
Mailing Address - Country:US
Mailing Address - Phone:303-993-9767
Mailing Address - Fax:
Practice Address - Street 1:6650 W 44TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4711
Practice Address - Country:US
Practice Address - Phone:303-993-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0008000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy