Provider Demographics
NPI:1508369646
Name:MADLENA PERFORMANCE THERAPY, LLC
Entity Type:Organization
Organization Name:MADLENA PERFORMANCE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADLENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:715-544-1500
Mailing Address - Street 1:73 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2378
Mailing Address - Country:US
Mailing Address - Phone:715-544-1500
Mailing Address - Fax:715-544-1505
Practice Address - Street 1:73 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-544-1500
Practice Address - Fax:715-544-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6530024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty