Provider Demographics
NPI:1376041541
Name:MADANE, BHAGWANT L
Entity Type:Individual
Prefix:
First Name:BHAGWANT
Middle Name:L
Last Name:MADANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 MILLWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4562
Mailing Address - Country:US
Mailing Address - Phone:909-435-1316
Mailing Address - Fax:
Practice Address - Street 1:1481 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-2433
Practice Address - Country:US
Practice Address - Phone:540-437-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist