Provider Demographics
NPI:1063590388
Name:HALEY-REZAC, DYANNA (PT DPT OCS CSCS CKTP)
Entity type:Individual
Prefix:DR
First Name:DYANNA
Middle Name:
Last Name:HALEY-REZAC
Suffix:
Gender:F
Credentials:PT DPT OCS CSCS CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 N UNION BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2268
Mailing Address - Country:US
Mailing Address - Phone:719-465-1502
Mailing Address - Fax:719-465-2087
Practice Address - Street 1:1817 N UNION BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2268
Practice Address - Country:US
Practice Address - Phone:719-465-1502
Practice Address - Fax:719-465-2087
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8111OtherLICENSE#