Provider Demographics
NPI:1487942249
Name:MADSON, KATIE ALICE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ALICE
Last Name:MADSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13178 WYANDOT STREET
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234
Mailing Address - Country:US
Mailing Address - Phone:801-592-7572
Mailing Address - Fax:
Practice Address - Street 1:1551 PROFESSIONAL LN UNIT 145
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6968
Practice Address - Country:US
Practice Address - Phone:720-494-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-11344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist