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General NPI Number Information
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NPI Number | 1265163844
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR PT
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 2349 W LINDA DR
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City | LOVELAND
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State | CO
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Zip | 80537-7217
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Country | US
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Telephone | 970-408-1716
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Fax | 970-408-2488
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Provider Business Mailing Address
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Address Line | 2349 W LINDA DR
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City | LOVELAND
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State | CO
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Zip | 80537-7217
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Country | US
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Telephone | 970-408-1716
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Fax | 970-408-2488
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS LOLLIS
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Credential | DPT
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Telephone | 970-408-1716
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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 |
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