Healthcare Provider Details

I. General information

NPI: 1922911072
Provider Name (Legal Business Name): MADYSON TALBOT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E 61ST ST N
PARK CITY KS
67219-1953
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 316-361-5425
  • Fax: 316-361-3615
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberT-06588
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: