Healthcare Provider Details

I. General information

NPI: 1235049024
Provider Name (Legal Business Name): MADISON MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 TEJON ST STE 201
DENVER CO
80211-1813
US

IV. Provider business mailing address

4736 PENNSYLVANIA ST
DENVER CO
80216-2738
US

V. Phone/Fax

Practice location:
  • Phone: 614-390-5525
  • Fax:
Mailing address:
  • Phone: 614-390-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0025453
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: