MEDICARE: LEAH MACK 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

General Provider Information

NPI Number	:	1457188385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH MACK DPT

Provider Business Mailing Address
First Line	:	595 CHAPEL HILLS DR STE 11
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1024
Country	:	US
Telephone Number	:	719-285-7127
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 CHAPEL HILLS DR STE 11
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1024
Country	:	US
Telephone Number	:	719-285-7127
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	06/02/2026

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Directions to “ LEAH MACK DPT” Practice Location

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