Provider Demographics
NPI:1598972895
Name:MADALENO, JAMES ALLAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLAN
Last Name:MADALENO
Suffix:
Gender:M
Credentials:ATC
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF KENTUCKY EJ NUTTER TRAINING FACILITY
Mailing Address - Street 2:136 SPORTS CENTER DRIVE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40506-0001
Mailing Address - Country:US
Mailing Address - Phone:859-257-6521
Mailing Address - Fax:859-257-8953
Practice Address - Street 1:UNIVERSITY OF KENTUCKY EJ NUTTER TRAINING FACILITY
Practice Address - Street 2:136 SPORTS CENTER DRIVE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-0001
Practice Address - Country:US
Practice Address - Phone:859-257-6521
Practice Address - Fax:859-257-8953
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYAT322171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor