Provider Demographics
NPI:1124788013
Name:HUCK, ADDISON GRAE (DPT)
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:GRAE
Last Name:HUCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 CENTRE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1887
Mailing Address - Country:US
Mailing Address - Phone:970-224-4141
Mailing Address - Fax:970-797-1227
Practice Address - Street 1:1024 CENTRE AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1887
Practice Address - Country:US
Practice Address - Phone:970-224-4141
Practice Address - Fax:970-797-1227
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4729225100000X
225100000X
CO19008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist