Healthcare Provider Details

I. General information

NPI: 1790821403
Provider Name (Legal Business Name): HOLTBY & BONACK PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 AUSTIN BLUFFS PKWY STE 100
COLORADO SPRINGS CO
80918-7861
US

IV. Provider business mailing address

1825 AUSTIN BLUFFS PKWY #100
COLORADO SPRINGS CO
80918
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-9282
  • Fax: 719-599-9283
Mailing address:
  • Phone: 719-599-9282
  • Fax: 719-599-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY D BONACK
Title or Position: CO OWNER
Credential: PT DO MPC
Phone: 719-599-9282