Provider Demographics
NPI:1770037079
Name:MADISON, TIMOTHY GRANT II (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GRANT
Last Name:MADISON
Suffix:II
Gender:M
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 1:1260 SW 66TH AVE APT 5100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6077
Mailing Address - Country:US
Mailing Address - Phone:503-869-3664
Mailing Address - Fax:
Practice Address - Street 1:1260 SW 66TH AVE APT 5100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6077
Practice Address - Country:US
Practice Address - Phone:503-869-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist