MEDICARE: BRETT HAEUPTLE PT

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	0018455	CO

General Provider Information

NPI Number	:	1528791589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT HAEUPTLE PT

Provider Business Mailing Address
First Line	:	1495 GARDEN OF THE GODS RD STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3429
Country	:	US
Telephone Number	:	719-785-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	1495 GARDEN OF THE GODS RD STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3429
Country	:	US
Telephone Number	:	719-785-1169
Fax Number	:

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

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	07/07/2022

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Directions to “ BRETT HAEUPTLE PT” Practice Location

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