Active NPI
Timothy Haacker, DPT
- Physical Therapist
- Salt Lake City, UT
National Provider Identifier
1114278397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8225227-2401
- Practice address
- 1138 E Wilmington Ave
Salt Lake City, UT 84106-2819 - Phone
- (801) 581-2000
- NPI assigned
- Sep 27, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8225227-2401 | UT | Primary |
Addresses
Primary practice location
1138 E Wilmington Ave
Salt Lake City, UT 84106-2819
Mailing address
2100 E Bengal Blvd
E302
Cottonwood Heights, UT 84121-7135
Phone (262) 721-7095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8225227-2401 | UT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348704000000",
"number": "1114278397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 E BENGAL BLVD",
"address_2": "E302",
"city": "COTTONWOOD HEIGHTS",
"state": "UT",
"postal_code": "841217135",
"telephone_number": "262-721-7095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1138 E WILMINGTON AVE",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841062819",
"telephone_number": "801-581-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAACKER",
"first_name": "TIMOTHY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-27",
"last_updated": "2012-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "8225227-2401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.