Provider Demographics
NPI:1508375106
Name:MADISON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MADISON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-201-0784
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:SD
Mailing Address - Zip Code:57349-0039
Mailing Address - Country:US
Mailing Address - Phone:605-772-2131
Mailing Address - Fax:605-772-2041
Practice Address - Street 1:411 SE 10TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-3571
Practice Address - Country:US
Practice Address - Phone:605-201-0784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy