Provider Demographics
NPI:1609857796
Name:MADTES AUGHENBAUGH PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:MADTES AUGHENBAUGH PHYSICAL THERAPY SERVICES
Other - Org Name:PHYSICAL THERAPY & SPORTS REHABILITATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-7480
Mailing Address - Street 1:1910 N CHURCH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5632
Mailing Address - Country:US
Mailing Address - Phone:336-274-7480
Mailing Address - Fax:336-274-8903
Practice Address - Street 1:1910 N CHURCH ST
Practice Address - Street 2:SUITE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5632
Practice Address - Country:US
Practice Address - Phone:336-274-7480
Practice Address - Fax:336-274-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1423Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER