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NPI Code Detail

MEDICARE: STEPHEN W MADEN PT

MEDICARE: STEPHEN W MADEN PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10289WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174527790
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN W MADEN PT
Provider Business Mailing Address
First Line : 1836 SOUTH AVE
Second Line :
City : LA CROSSE
State : WI
Zip : 54601-5429
Country : US
Telephone Number : 608-782-7300
Fax Number :
Provider Business Practice Location Address
First Line : 3111 GUNDERSEN DRIVE
Second Line :
City : ONALASKA
State : WI
Zip : 54650-8512
Country : US
Telephone Number : 608-782-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 07/08/2007

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