Provider Demographics
NPI:1669883989
Name:MADRIGAL, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-1737
Mailing Address - Country:US
Mailing Address - Phone:913-481-7269
Mailing Address - Fax:
Practice Address - Street 1:9403 W 49TH ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66203-1737
Practice Address - Country:US
Practice Address - Phone:913-481-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant