MEDICARE: JOSEPH KHALIL HADDAD LPT

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	PTL7509	CO

General Provider Information

NPI Number	:	1578788725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH KHALIL HADDAD LPT

Provider Business Mailing Address
First Line	:	PO BOX 512
Second Line	:
City	:	U S A F ACADEMY
State	:	CO
Zip	:	80840-0512
Country	:	US
Telephone Number	:	719-649-9697
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 PRINTERS PKWY
Second Line	:	SUITE 125
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-6100
Country	:	US
Telephone Number	:	719-635-8622
Fax Number	:

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

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	07/08/2007

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