Provider Demographics
NPI:1366122236
Name:HOLYOAK SPORTS PERFORMANCE
Entity type:Organization
Organization Name:HOLYOAK SPORTS PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLYOAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:385-283-1265
Mailing Address - Street 1:2072 N RED YEARLING DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3949
Mailing Address - Country:US
Mailing Address - Phone:630-699-3748
Mailing Address - Fax:
Practice Address - Street 1:450 N 1500 W STE A
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2829
Practice Address - Country:US
Practice Address - Phone:385-283-1265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy