Provider Demographics
NPI:1689446643
Name:PEDERSEN, MADISON MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 6TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1115
Mailing Address - Country:US
Mailing Address - Phone:814-515-1049
Mailing Address - Fax:
Practice Address - Street 1:5930 6TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1115
Practice Address - Country:US
Practice Address - Phone:814-515-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist