Provider Demographics
NPI:1477538569
Name:HADDOCK, KELLY R SLONE (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R SLONE
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2233 ACADEMY PLACE
Mailing Address - Street 2:STE 50
Mailing Address - City:COLORADA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-475-0808
Mailing Address - Fax:719-475-8822
Practice Address - Street 1:1604 PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919
Practice Address - Country:US
Practice Address - Phone:719-630-3193
Practice Address - Fax:719-630-3195
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT8072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist