Healthcare Provider Details

I. General information

NPI: 1568425981
Provider Name (Legal Business Name): ROBERT E HOLTBY MA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 AUSTIN BLUFFS PKWY 100
COLORADO SPRINGS CO
80918-7871
US

IV. Provider business mailing address

1825 AUSTIN BLUFFS PKWY 100
COLORADO SPRINGS CO
80918-7871
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-8550
  • Fax: 719-218-9200
Mailing address:
  • Phone: 719-599-8550
  • Fax: 719-218-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2755
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: