MEDICARE: AUDREY LEIGH SHORT PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0015086	CO

General Provider Information

NPI Number	:	1215452057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY LEIGH SHORT PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 96217
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85072-6217
Country	:	US
Telephone Number	:	678-837-7176
Fax Number	:	404-777-1311

Provider Business Practice Location Address
First Line	:	5825 DELMONICO DR STE 300
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80919-2244
Country	:	US
Telephone Number	:	719-577-4104
Fax Number	:	719-575-0872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2017
Last Update Date	:	03/09/2026

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