Provider Demographics
NPI:1669994398
Name:GOLDEN, MADISON MACKENZIE (DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MACKENZIE
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILLIAM POPE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7550
Mailing Address - Country:US
Mailing Address - Phone:843-705-9440
Mailing Address - Fax:843-705-9445
Practice Address - Street 1:10 WILLIAM POPE DR STE 3
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7550
Practice Address - Country:US
Practice Address - Phone:843-705-9440
Practice Address - Fax:843-705-9445
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist