Provider Demographics
NPI:1811561624
Name:GRAFTON, MADALYN LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:LOUISE
Last Name:GRAFTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:703-822-0039
Mailing Address - Fax:703-822-0211
Practice Address - Street 1:6564 LOISDALE CT STE 500
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1823
Practice Address - Country:US
Practice Address - Phone:703-822-0039
Practice Address - Fax:703-822-0211
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist