Provider Demographics
NPI:1255303608
Name:MADONIA, LISA M (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:MADONIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16103 E BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2216
Mailing Address - Country:US
Mailing Address - Phone:480-837-2470
Mailing Address - Fax:
Practice Address - Street 1:16856 E LAST TRAIL DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6640
Practice Address - Country:US
Practice Address - Phone:480-837-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ178782OtherACHESS
S99272Medicare UPIN
60017Medicare ID - Type Unspecified