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Individual

TODD KARL HAACKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
1055 N 500 W, PROVO, UT 84604-3305
(801) 429-0610
(801) 429-0629
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11412274-2401
UT

Other

Enumeration date
03/20/2023
Last updated
06/07/2023
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