Healthcare Provider Details

I. General information

NPI: 1255828034
Provider Name (Legal Business Name): MADISON PHYSICAL THERAPY & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 E MIFFLIN ST
MADISON WI
53703-4205
US

IV. Provider business mailing address

3733 ROSS ST
MADISON WI
53705-5225
US

V. Phone/Fax

Practice location:
  • Phone: 608-957-7088
  • Fax:
Mailing address:
  • Phone: 608-957-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY SUSAN VIRAG
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, OCS, CERT. DN
Phone: 608-957-7088