Provider Demographics
NPI:1730793167
Name:GARST, MADISON (PTA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:GARST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 S ARGONNE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2308
Mailing Address - Country:US
Mailing Address - Phone:172-028-1430
Mailing Address - Fax:
Practice Address - Street 1:601 CHAMBERS RD STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-7130
Practice Address - Country:US
Practice Address - Phone:303-577-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0014849225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTA.0014849OtherDEPARTMENT OF REGULATORY AGENCIES