Provider Demographics
NPI:1962967703
Name:FARMER, MADELINE (ATC, PT, DPT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:FARMER
Suffix:
Gender:
Credentials:ATC, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:970-722-1060
Mailing Address - Fax:970-722-1099
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:970-722-1060
Practice Address - Fax:970-722-1099
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018883225100000X
COPTL0018883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL0018883OtherLICENSE