Provider Demographics
NPI:1922654326
Name:FERRELL, MADISON E (DPT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:E
Last Name:FERRELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10014 NORTH RODNEY PARHAM
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227
Mailing Address - Country:US
Mailing Address - Phone:501-224-5454
Mailing Address - Fax:501-224-5460
Practice Address - Street 1:10014 NORTH RODNEY PARHAM
Practice Address - Street 2:SUITE 103
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227
Practice Address - Country:US
Practice Address - Phone:501-224-5454
Practice Address - Fax:501-224-5460
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4639OtherPT LICENSE