Provider Demographics
NPI:1336653542
Name:MADSEN, JANINE SUZANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:SUZANNE
Last Name:MADSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 W LIBERTY ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2604
Mailing Address - Country:US
Mailing Address - Phone:610-351-9555
Mailing Address - Fax:
Practice Address - Street 1:1227 W LIBERTY ST STE 204
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2604
Practice Address - Country:US
Practice Address - Phone:610-351-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG011871225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist