Healthcare Provider Details

I. General information

NPI: 1922885250
Provider Name (Legal Business Name): MADISON DOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 BREEZEWOOD AVE
FAYETTEVILLE NC
28303-5534
US

IV. Provider business mailing address

1170 BOONE HALL WAY APT 308
FAYETTEVILLE NC
28303-5999
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-4100
  • Fax:
Mailing address:
  • Phone: 972-679-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: