Provider Demographics
NPI:1780844969
Name:MADDEN INVESTMENTS LLC
Entity Type:Organization
Organization Name:MADDEN INVESTMENTS LLC
Other - Org Name:MELBOURNE ATHLETIC CLUB PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LORRAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-254-9777
Mailing Address - Street 1:1411 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6518
Mailing Address - Country:US
Mailing Address - Phone:321-254-9777
Mailing Address - Fax:
Practice Address - Street 1:1411 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6518
Practice Address - Country:US
Practice Address - Phone:321-254-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MELBOURNE ATHLETIC CLUB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHS7394261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service