Provider Demographics
NPI:1427926179
Name:HOLSTEIN, LORI (PTA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 E NICHOLS CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3476
Mailing Address - Country:US
Mailing Address - Phone:631-793-8253
Mailing Address - Fax:
Practice Address - Street 1:750 W HAMPDEN AVE STE 425
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2099
Practice Address - Country:US
Practice Address - Phone:720-647-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014062225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant