Provider Demographics
NPI:1215525795
Name:WILTGEN, MADELINE (DPT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:WILTGEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W CENTENNIAL DR UNIT G
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-8597
Mailing Address - Country:US
Mailing Address - Phone:612-710-0410
Mailing Address - Fax:
Practice Address - Street 1:2479 S CLERMONT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6588
Practice Address - Country:US
Practice Address - Phone:720-974-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296948225100000X
CO0017357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist