MEDICARE: MARKI TOMIKO FONG PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	1382469	TX
2	225100000X	Physical Therapist	0020500	CO

General Provider Information

NPI Number	:	1215711379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARKI TOMIKO FONG PT, DPT

Provider Business Mailing Address
First Line	:	4714 MILESTONE LN STE B
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7908
Country	:	US
Telephone Number	:	303-660-5349
Fax Number	:	303-660-5379

Provider Business Practice Location Address
First Line	:	4714 MILESTONE LN STE B
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7908
Country	:	US
Telephone Number	:	303-660-5349
Fax Number	:	303-660-5379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	04/23/2025

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