Healthcare Provider Details

I. General information

NPI: 1053157271
Provider Name (Legal Business Name): MADISON JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON SEYMOUR

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 E MARION ST
SHELBY NC
28150-4843
US

IV. Provider business mailing address

12840 RIDGEWOOD RD
ANCHORAGE AK
99516-2986
US

V. Phone/Fax

Practice location:
  • Phone: 704-471-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058249T
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05015661A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: