Provider Demographics
NPI:1720267818
Name:HOLM, NICHOLAS B (MSPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:B
Last Name:HOLM
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S CHERRY ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1236
Mailing Address - Country:US
Mailing Address - Phone:303-333-3493
Mailing Address - Fax:
Practice Address - Street 1:7821 W 38TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6185
Practice Address - Country:US
Practice Address - Phone:303-420-1590
Practice Address - Fax:303-420-4694
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO810966Medicare PIN