Provider Demographics
NPI:1831353416
Name:MADONIA, ADAM DOMINIC (PT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DOMINIC
Last Name:MADONIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RIVER RD
Mailing Address - Street 2:APT B
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-6613
Mailing Address - Country:US
Mailing Address - Phone:917-992-4702
Mailing Address - Fax:
Practice Address - Street 1:32 BUCK RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2700
Practice Address - Country:US
Practice Address - Phone:603-643-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3452225100000X
VT040.0045094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist