Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1003335910 |
---|---|
Provider Name | Madison Haller |
First Address | Littleton, CO 80163-0001 |
Second Address | Highlands Ranch, CO 80126-5244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 12/09/2017 |