Individual
MICHAEL J BOLANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2500 E PROSPECT RD, FORT COLLINS, CO 80525
(970) 493-0112
Mailing address
2695 ROCKY MOUNTAIN AVE, STE 150, LOVELAND, CO 80538-9071
(970) 624-2404
(720) 718-0993
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTL.0008448
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123322000
—
WY
05
—
82852855
—
CO
01
—
P00402182
RR MEDICARE
CO
Enumeration date
08/23/2006
Last updated
04/23/2019
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