=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376067454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN NATHANIEL HASKINS DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2017
-----------------------------------------------------
Last Update Date | 11/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 88 INVERNESS CIR E UNIT A106
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-925-1050
-----------------------------------------------------
Fax | 808-888-8236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 88 INVERNESS CIR E UNIT A106
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-925-1050
-----------------------------------------------------
Fax | 808-888-8236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PTH8519
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------