Provider Demographics
NPI:1285228411
Name:BERGER, MADELINE NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:NICOLE
Last Name:BERGER
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 1:2795 N SPEER BLVD APT 430A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4292
Mailing Address - Country:US
Mailing Address - Phone:717-449-9919
Mailing Address - Fax:
Practice Address - Street 1:11 W DRY CREEK CT
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4484
Practice Address - Country:US
Practice Address - Phone:303-795-0428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist