Healthcare Provider Details

I. General information

NPI: 1649732348
Provider Name (Legal Business Name): JANELLE ELIZABETH MCFADDEN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 REGIS BLVD
DENVER CO
80221-8926
US

IV. Provider business mailing address

2513 E 126TH WAY
THORNTON CO
80241-2761
US

V. Phone/Fax

Practice location:
  • Phone: 303-946-5774
  • Fax:
Mailing address:
  • Phone: 303-946-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2000029572
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: