Healthcare Provider Details

I. General information

NPI: 1528894615
Provider Name (Legal Business Name): MADELINE KATE MCCORMICK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY
DENVER CO
80220-6210
US

IV. Provider business mailing address

4682 BEELER CT APT 322
DENVER CO
80238-4470
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-7450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTL.0020134
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: