Healthcare Provider Details

I. General information

NPI: 1730002544
Provider Name (Legal Business Name): MADISON HUFFMAN HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E LAKE DR
BRANDON MS
39047-6332
US

IV. Provider business mailing address

214 E LAKE DR
BRANDON MS
39047-6332
US

V. Phone/Fax

Practice location:
  • Phone: 573-683-1204
  • Fax: 573-683-1204
Mailing address:
  • Phone: 573-683-1204
  • Fax: 573-683-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-7358
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: