Healthcare Provider Details

I. General information

NPI: 1700531076
Provider Name (Legal Business Name): HALEY SHIELDS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11681 VOYAGER PKWY STE 150
COLORADO SPRINGS CO
80921-3864
US

IV. Provider business mailing address

2816 JANITELL RD
COLORADO SPRINGS CO
80906-4141
US

V. Phone/Fax

Practice location:
  • Phone: 719-344-9342
  • Fax: 719-375-3531
Mailing address:
  • Phone: 719-527-0848
  • Fax: 719-471-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018205
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: