Individual provider Active NPI

Addison Grae Huck, DPT

  • Physical Therapist
  • Fort Collins, CO
National Provider Identifier
1124788013
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
19008 Issued in CO
Practice address
1024 Centre Ave Ste 100
Fort Collins, CO 80526-1887
Phone
(970) 224-4141
Fax
(970) 797-1227
NPI assigned
Dec 20, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4729 NV
Physical Therapist 225100000X
Physical Therapist 225100000X 19008 CO Primary

Addresses

Primary practice location

1024 Centre Ave Ste 100
Fort Collins, CO 80526-1887

Mailing address

1024 Centre Ave Ste 100
Fort Collins, CO 80526-1887
Phone (970) 224-4141

Other practice location 1

1550 W Craig Rd Ste 210
North Las Vegas, NV 89032-0329
Phone (702) 360-9142

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230412002152 CO Practitioner - Physical Therapist in Private Practice 9436542503 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proactive Physical Therapy and Exercise Center, IncGroup PAC ID 8022190826, 6 clinicians

Practice addresses (Care Compare)

1024 Centre Ave
Suite 100
Fort Collins, CO 80526-1887
Phone (970) 224-4141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19008COMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proactive Physical Therapy and Exercise Center, Inc Physical Therapist CurrentSince May 1, 2023 Accepting new patients

Locations

1024 Centre Ave
Ste 100
Fort Collins, CO 80526
Phone (970) 224-4141

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1124788013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 CENTRE AVE STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805261887",
            "telephone_number": "970-224-4141",
            "fax_number": "970-797-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 CENTRE AVE STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805261887",
            "telephone_number": "970-224-4141",
            "fax_number": "970-797-1227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1550 W Craig Rd Ste 210",
            "address_purpose": "LOCATION",
            "city": "North Las Vegas",
            "state": "NV",
            "postal_code": "890320329",
            "country_code": "US",
            "telephone_number": "702-360-9142",
            "fax_number": "702-649-0147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUCK",
        "first_name": "ADDISON",
        "middle_name": "GRAE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-20",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "4729",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "19008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.