Provider Demographics
NPI:1043945942
Name:BORN, MADELINE CLARE (CMT, NMT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:CLARE
Last Name:BORN
Suffix:
Gender:F
Credentials:CMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SHRADER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1874
Mailing Address - Country:US
Mailing Address - Phone:415-971-1622
Mailing Address - Fax:
Practice Address - Street 1:228 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2318
Practice Address - Country:US
Practice Address - Phone:415-675-8973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist