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General NPI Number Information
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NPI Number | 1154562403
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Entity Type | Individual
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Provider Name | LISA FERGUSON BOLIN DPT
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Gender | Female
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 4850 AUSTIN BLUFFS PKWY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-5069
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Country | US
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Telephone | 719-466-6800
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Fax | 719-694-1686
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Provider Business Mailing Address
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Address Line | 18740 SAINT ANDREWS DR
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City | MONUMENT
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State | CO
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Zip | 80132-8881
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0020880
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License Number State | CO
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