Provider Demographics
NPI:1013501501
Name:MADDISON, DREW EUGENE (PTA)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:EUGENE
Last Name:MADDISON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 S ANKENY BLVD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8995
Mailing Address - Country:US
Mailing Address - Phone:515-289-9541
Mailing Address - Fax:515-446-3642
Practice Address - Street 1:2006 S ANKENY BLVD BLDG 5
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8995
Practice Address - Country:US
Practice Address - Phone:515-289-9541
Practice Address - Fax:515-446-3642
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA102043225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant