Provider Demographics
NPI:1295783678
Name:HOLISTIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:HOLISTIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:KREISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-226-1448
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:3010 14TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2610
Practice Address - Country:US
Practice Address - Phone:720-226-1448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC806277OtherMEDICARE PTAN
COHO675746OtherBCBS
COC806277OtherMEDICARE PTAN