Provider Demographics
NPI:1275116402
Name:THOMAS, MADELEINE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:MCCARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:2756 RICHLANDS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-3611
Practice Address - Country:US
Practice Address - Phone:910-378-0147
Practice Address - Fax:910-219-4119
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist