Basic Information
| Provider Information | |||||||||
| NPI: | 1801879903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHONE CLINIC SERVICES, LLC | ||||||||
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| OtherOrganizationName: | HEALTHONE BRONCOS SPORTS MEDICINE & REHABILITATION CENTER - THORNTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9195 GRANT ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802294385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034517700 | ||||||||
| FaxNumber: | 3032529474 | ||||||||
| Practice Location | |||||||||
| Address1: | 9195 GRANT ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802294385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034517700 | ||||||||
| FaxNumber: | 3032529474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BIRMINGHAM | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6153737625 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.