Healthcare Provider Details

I. General information

NPI: 1801791884
Provider Name (Legal Business Name): MADISON S WHITAKER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 S LAURELHURST DR
SALT LAKE CITY UT
84108-3309
US

IV. Provider business mailing address

1795 S LAURELHURST DR
SALT LAKE CITY UT
84108-3309
US

V. Phone/Fax

Practice location:
  • Phone: 603-944-1369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5030
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: