Healthcare Provider Details

I. General information

NPI: 1578788725
Provider Name (Legal Business Name): JOSEPH KHALIL HADDAD LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PRINTERS PKWY SUITE 125
COLORADO SPRINGS CO
80910-6100
US

IV. Provider business mailing address

PO BOX 512
U S A F ACADEMY CO
80840-0512
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-8622
  • Fax:
Mailing address:
  • Phone: 719-649-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL7509
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: