Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Todd Karl Haacke, DPT

Individual provider Physical Therapist · NPI 1154023513

Todd Karl Haacke, DPT is a Physical Therapist in Private Practice in Provo, Utah. Qualified in 2019, 7 years ago. Practices with Revere Health PC, a 410-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
7
Licensed in
UT
In the registry since
2023
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

1055 N 500 W
Provo, UT 84604-3305
Phone: (801) 429-0610
Fax: (801) 429-0629
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 11412274-2401 (UT)

Record details

NPI number1154023513
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorYes
NPI enumeratedMarch 20, 2023
Last updated in NPPESJune 7, 2023
Certification dateJune 7, 2023
Mailing address1055 N 500 W, Attn: Credentialing, Provo, UT 84604-3305

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Revere Health Pc — 410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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