Healthcare Provider Details

I. General information

NPI: 1194284620
Provider Name (Legal Business Name): MADISON BRINKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GOSSMAN RD
SOUTHERN PINES NC
28387-2225
US

IV. Provider business mailing address

116 ARTHUR DR
THOMASVILLE NC
27360-6217
US

V. Phone/Fax

Practice location:
  • Phone: 910-246-1000
  • Fax:
Mailing address:
  • Phone: 336-250-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA6798
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: