Provider Demographics
NPI:1598852402
Name:MADISON, JOSHUA THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:THOMAS
Last Name:MADISON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:900 ORANGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-1103
Practice Address - Country:US
Practice Address - Phone:814-736-9600
Practice Address - Fax:814-736-9888
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist