Provider Demographics
NPI:1568210482
Name:EKINS, MADELINE KATE (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:KATE
Last Name:EKINS
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 E 3300 S APT 211
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4357
Mailing Address - Country:US
Mailing Address - Phone:801-884-9966
Mailing Address - Fax:
Practice Address - Street 1:4554 FORESTDALE DR UNIT C16
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-1392
Practice Address - Country:US
Practice Address - Phone:435-494-1336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139679782401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist