Provider Demographics
NPI:1356641575
Name:MADDERN, ASHLEY MARIE (DPT)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:MARIE
Last Name:MADDERN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 ROUNDSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5157
Mailing Address - Country:US
Mailing Address - Phone:218-248-9524
Mailing Address - Fax:
Practice Address - Street 1:848 1ST AVE N STE 120
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6093
Practice Address - Country:US
Practice Address - Phone:239-384-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25854225100000X
MN8622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist