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1154023513
TODD KARL HAACKE
PROVO, UT
NPI
1154023513
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: UT 11412274-2401)
Enumeration Date
2023-03-20
Last Update Date
2023-06-07
Business Address
TODD KARL HAACKE DPT
1055 N 500 W
PROVO, UT 84604-3305
Phone number: 801-429-0610
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Mailing Address
TODD KARL HAACKE DPT
1055 N 500 W ATTN: CREDENTIALING
PROVO, UT 84604-3305
Phone number: 801-354-8225
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