Provider Demographics
NPI:1265146930
Name:AXON, MADISON P (DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:P
Last Name:AXON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:P
Other - Last Name:GERLACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:221 W YOUNG HIGH PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3051
Mailing Address - Country:US
Mailing Address - Phone:865-573-6458
Mailing Address - Fax:865-577-8147
Practice Address - Street 1:221 W YOUNG HIGH PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3051
Practice Address - Country:US
Practice Address - Phone:865-573-6458
Practice Address - Fax:865-577-8147
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist