Healthcare Provider Details

I. General information

NPI: 1508518812
Provider Name (Legal Business Name): MADISON LAINE SILVERS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W WILLIAM CANNON DR STE 409
AUSTIN TX
78745-5290
US

IV. Provider business mailing address

11605 OAKWOOD DR
AUSTIN TX
78753-2257
US

V. Phone/Fax

Practice location:
  • Phone: 512-852-8434
  • Fax: 512-852-8435
Mailing address:
  • Phone: 913-680-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: