Provider Demographics
NPI:1053776559
Name:MADRUGA REHAB CENTERS, LLC
Entity type:Organization
Organization Name:MADRUGA REHAB CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARQUTIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CATALLO-MADRUGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CFDN, CMT,
Authorized Official - Phone:303-773-0771
Mailing Address - Street 1:7375 E ORCHARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2569
Mailing Address - Country:US
Mailing Address - Phone:303-773-0771
Mailing Address - Fax:303-773-0773
Practice Address - Street 1:7375 E ORCHARD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2569
Practice Address - Country:US
Practice Address - Phone:303-773-0771
Practice Address - Fax:303-773-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO.PTL8977261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA1609Medicare UPIN
COCOAAA1068Medicare UPIN