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General NPI Number Information
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NPI Number | 1013047752
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Entity Type | Organization
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Legal Business Name | MARDER PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 34061 FOREST PARK DRIVE
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City | ELIZABETH
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State | CO
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Zip | 80107
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Country | US
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Telephone | 303-646-9782
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Fax | 303-646-9782
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Provider Business Mailing Address
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Address Line | PO BOX 1122
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City | ELIZABETH
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State | CO
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Zip | 80107-1122
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Country | US
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Telephone | 303-646-9782
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Fax | 303-646-9782
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA R MARDER
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Credential | PT
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Telephone | 303-646-9782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4108
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License Number State | CO
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