1982217618 NPI number — JULIA MADISON DPT

Table of content: JULIA MADISON DPT (NPI 1982217618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982217618 NPI number — JULIA MADISON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADISON
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982217618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 NEW FIDELITY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-842-9323
Provider Business Mailing Address Fax Number:
570-842-9362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4948 PENNELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19014-1867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-494-8730
Provider Business Practice Location Address Fax Number:
610-494-9671
Provider Enumeration Date:
08/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT028722 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT028722 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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