Provider Demographics
NPI:1578788725
Name:HADDAD, JOSEPH KHALIL (LPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KHALIL
Last Name:HADDAD
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:U S A F ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-0512
Mailing Address - Country:US
Mailing Address - Phone:719-649-9697
Mailing Address - Fax:
Practice Address - Street 1:155 PRINTERS PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-6100
Practice Address - Country:US
Practice Address - Phone:719-635-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL7509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist