MEDICARE: MR. ROBERT E HOLTBY MA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	2755	CO

General Provider Information

NPI Number	:	1568425981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT E HOLTBY MA PT

Provider Business Mailing Address
First Line	:	1825 AUSTIN BLUFFS PKWY
Second Line	:	100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7871
Country	:	US
Telephone Number	:	719-599-8550
Fax Number	:	719-218-9200

Provider Business Practice Location Address
First Line	:	1825 AUSTIN BLUFFS PKWY
Second Line	:	100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7871
Country	:	US
Telephone Number	:	719-599-8550
Fax Number	:	719-218-9200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	09/14/2009

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