Provider Demographics
NPI:1073029153
Name:KREBS, MADISON (ATC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KREBS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GRAYLYN CREST DR
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-9418
Mailing Address - Country:US
Mailing Address - Phone:570-412-9165
Mailing Address - Fax:
Practice Address - Street 1:221 GRAYLYN CREST DR
Practice Address - Street 2:
Practice Address - City:NEW COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17856-9418
Practice Address - Country:US
Practice Address - Phone:570-412-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer