Healthcare Provider Details

I. General information

NPI: 1538414958
Provider Name (Legal Business Name): JESSICA NOELLE HUFFMAN PT, DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 FLINTRIDGE DR STE 101
COLORADO SPRINGS CO
80918-1896
US

IV. Provider business mailing address

5770 FLINTRIDGE DR STE 101
COLORADO SPRINGS CO
80918-1896
US

V. Phone/Fax

Practice location:
  • Phone: 719-466-6800
  • Fax:
Mailing address:
  • Phone: 719-466-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1220187
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018082
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: