Provider Demographics
NPI:1497444129
Name:ROOT, MADISON NANCY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:NANCY
Last Name:ROOT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SKOWHEGAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-3479
Mailing Address - Country:US
Mailing Address - Phone:207-453-1330
Mailing Address - Fax:207-453-1333
Practice Address - Street 1:95 SKOWHEGAN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3479
Practice Address - Country:US
Practice Address - Phone:207-453-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist