Healthcare Provider Details

I. General information

NPI: 1760142921
Provider Name (Legal Business Name): MADISON MICHELLE WOODBURY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON MICHELLE CHOATE DPT

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W BETHEL RD STE 400
COPPELL TX
75019-4477
US

IV. Provider business mailing address

PO BOX 2650
COPPELL TX
75019-8607
US

V. Phone/Fax

Practice location:
  • Phone: 972-304-9100
  • Fax: 972-304-9048
Mailing address:
  • Phone: 972-724-2400
  • Fax: 972-724-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1357445
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: