Provider Demographics
NPI:1336592641
Name:MADISON, CAITLIN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 HUNTER RD APT 414
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6407
Mailing Address - Country:US
Mailing Address - Phone:214-729-0027
Mailing Address - Fax:
Practice Address - Street 1:2913 HUNTER RD APT 414
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6407
Practice Address - Country:US
Practice Address - Phone:214-729-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer