Provider Demographics
NPI:1164206736
Name:HICHUE, TAYAH AUTUMN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAYAH
Middle Name:AUTUMN
Last Name:HICHUE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 TUTT BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3502
Mailing Address - Country:US
Mailing Address - Phone:719-596-0880
Mailing Address - Fax:719-596-0899
Practice Address - Street 1:6160 TUTT BLVD STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3502
Practice Address - Country:US
Practice Address - Phone:719-596-0880
Practice Address - Fax:719-596-0899
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist