Healthcare Provider Details

I. General information

NPI: 1093354938
Provider Name (Legal Business Name): ANDREW SHORT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/15/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5643 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-3658
US

IV. Provider business mailing address

5025 SLICKROCK DR
COLORADO SPRINGS CO
80923-7680
US

V. Phone/Fax

Practice location:
  • Phone: 720-316-9974
  • Fax: 720-294-0332
Mailing address:
  • Phone: 573-776-0702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0017992
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: