MEDICARE: HOLTBY & BONACK PTR

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

General Provider Information

NPI Number	:	1790821403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLTBY & BONACK PTR

Provider Business Mailing Address
First Line	:	1825 AUSTIN BLUFFS PKWY #100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918
Country	:	US
Telephone Number	:	719-599-9282
Fax Number	:	719-599-9283

Provider Business Practice Location Address
First Line	:	1825 AUSTIN BLUFFS PKWY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7861
Country	:	US
Telephone Number	:	719-599-9282
Fax Number	:	719-599-9283

Authorized Official
Title or Position	:	CO OWNER
Name	:	TIMOTHY D BONACK
Credential	:	PT DO MPC
Telephone Number	:	719-599-9282

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	02/19/2008

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