# CREEKSIDE PHYSICAL MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CREEKSIDE PHYSICAL MEDICINE PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1972101202
- **Legal business name:** CREEKSIDE PHYSICAL MEDICINE PLLC
- **Authorized official:** LOUISE THOMAS (PRACTICE MANAGER)
- **Authorized official phone:** (303) 489-2264

## Contact information

- **Practice address:** 600 S AIRPORT RD UNIT CD, LONGMONT, CO 80503-6475
- **Practice address phone:** (303) 494-2705
- **Mailing address:** 5387 MANHATTAN CIR STE 201, BOULDER, CO 80303-4283
- **Mailing address phone:** (303) 494-2705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/09/2020
- **Last updated:** 10/09/2020