Provider Demographics
NPI:1215711379
Name:FONG, MARKI TOMIKO (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARKI
Middle Name:TOMIKO
Last Name:FONG
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 MILESTONE LN STE B
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7908
Mailing Address - Country:US
Mailing Address - Phone:303-660-5349
Mailing Address - Fax:303-660-5379
Practice Address - Street 1:4714 MILESTONE LN STE B
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7908
Practice Address - Country:US
Practice Address - Phone:303-660-5349
Practice Address - Fax:303-660-5379
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13824692081S0010X
CO0020500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine