Provider Demographics
NPI:1003432006
Name:ROTH, MADISON KATE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:KATE
Last Name:ROTH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:KATE
Other - Last Name:MERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4930 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-1000
Mailing Address - Country:US
Mailing Address - Phone:989-928-7354
Mailing Address - Fax:
Practice Address - Street 1:4616 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3805
Practice Address - Country:US
Practice Address - Phone:989-355-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist