Healthcare Provider Details

I. General information

NPI: 1386625473
Provider Name (Legal Business Name): ROBERT O MADTES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 N CHURCH ST SUITE D
GREENSBORO NC
27405-5632
US

IV. Provider business mailing address

1910 N CHURCH ST SUITE D
GREENSBORO NC
27405-5632
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-7480
  • Fax: 336-274-8903
Mailing address:
  • Phone: 336-274-7480
  • Fax: 336-274-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1259
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: