Provider Demographics
NPI:1639702848
Name:WOODY, MADISON LEE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:LEE
Last Name:WOODY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-6841
Mailing Address - Country:US
Mailing Address - Phone:865-466-3827
Mailing Address - Fax:
Practice Address - Street 1:12050 ETRIS RD STE E150
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-8022
Practice Address - Country:US
Practice Address - Phone:770-801-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist