Healthcare Provider Details

I. General information

NPI: 1669320891
Provider Name (Legal Business Name): ELIZABETH BOLTON BS, MS, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/21/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SPRUCE ST STE 202
BOULDER CO
80302-5395
US

IV. Provider business mailing address

7495 LOWELL BLVD APT 22
WESTMINSTER CO
80030-4853
US

V. Phone/Fax

Practice location:
  • Phone: 414-507-3129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0027583
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT.0027583
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: