Healthcare Provider Details

I. General information

NPI: 1568355865
Provider Name (Legal Business Name): MADISON FAROUK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 AUSTIN BLUFFS PKWY STE 105
COLORADO SPRINGS CO
80918-5723
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 719-912-2110
  • Fax: 719-400-6413
Mailing address:
  • Phone: 719-912-2110
  • Fax: 719-400-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020931
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: