Provider Demographics
NPI:1164431466
Name:MADLENA, TROY A (DPT)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:MADLENA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2378
Mailing Address - Country:US
Mailing Address - Phone:715-544-1500
Mailing Address - Fax:715-544-1505
Practice Address - Street 1:73 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2378
Practice Address - Country:US
Practice Address - Phone:715-544-1500
Practice Address - Fax:715-544-1505
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WI6530024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40336400Medicaid