Provider Demographics
NPI:1932583283
Name:JAMES, MADISON MCKINLEY (DPT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MCKINLEY
Last Name:JAMES
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 1:1800 SE MOBERLY LN STE 6
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7017
Mailing Address - Country:US
Mailing Address - Phone:479-715-6330
Mailing Address - Fax:479-268-5144
Practice Address - Street 1:1800 SE MOBERLY LN STE 6
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7017
Practice Address - Country:US
Practice Address - Phone:479-715-6330
Practice Address - Fax:479-268-5144
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4812225100000X, 225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program