=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063379048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALEY YOST - PEDIATRIC PT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2026
-----------------------------------------------------
Last Update Date | 01/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 CLEMENT ST APT 200
-----------------------------------------------------
City | BASALT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81621-8482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-695-7731
-----------------------------------------------------
Fax | 844-562-0735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 CLEMENT ST APT 200
-----------------------------------------------------
City | BASALT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81621-8482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-695-7731
-----------------------------------------------------
Fax | 844-562-0735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/ OWNER
-----------------------------------------------------
Name | HALEY J YOST
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 484-695-7731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------