Kelly R Slone Haddock, PT
Individual provider Active NPI Physical Therapist · Colorado Springs, CO
NPI 1477538569 · NPPES record last updated Sep 17, 2010
Key facts
- NPI
- 1477538569
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT8072 (CO)
- Practice address
- 1604 Pikes Peak Ave
Colorado Springs, CO 80919 - Phone
- (719) 630-3193
- Fax
- (719) 630-3195
- NPI assigned
- Dec 12, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT8072 | CO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Action Potential RLLP | Physical Therapist | Past | Accepting new patients |
| Action Potential RLLP | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT8072 | CO | Yes |
Addresses
Primary practice location
1604 Pikes Peak Ave
Colorado Springs, CO 80919
Mailing address
2233 Academy Place
Ste 50
Colorada Springs, CO 80909
Phone (719) 475-0808
Other providers in Colorado Springs, CO
- Christian Hackett
- Kimberly Hackman
- Joseph Khalil Haddad
- Nancy Eleanor Haddad
- Ann M Haddenhorst
- Kevin M Haddock
- Carmina Hadley
- Jessica Haebig
- Daniel Walter Haecker
- Adam Haeffner
All providers in Colorado Springs, CO · Physical Therapist in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.