Healthcare Provider Details

I. General information

NPI: 1063379048
Provider Name (Legal Business Name): HALEY YOST - PEDIATRIC PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CLEMENT ST APT 200
BASALT CO
81621-8482
US

IV. Provider business mailing address

201 CLEMENT ST APT 200
BASALT CO
81621-8482
US

V. Phone/Fax

Practice location:
  • Phone: 484-695-7731
  • Fax: 844-562-0735
Mailing address:
  • Phone: 484-695-7731
  • Fax: 844-562-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: HALEY J YOST
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: DPT
Phone: 484-695-7731