Healthcare Provider Details

I. General information

NPI: 1154839710
Provider Name (Legal Business Name): MADASYN LEIGH HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADASYN LEIGH SMITH DPT

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 PARRISH ST STE 220
CANANDAIGUA NY
14424
US

IV. Provider business mailing address

75 HULBURT AVE
FAIRPORT NY
14450-2407
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-3920
  • Fax:
Mailing address:
  • Phone: 315-534-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: