Healthcare Provider Details

I. General information

NPI: 1629526611
Provider Name (Legal Business Name): NATHAN MADAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MOHAWK DR STE 100
TOMAHAWK WI
54487-2273
US

IV. Provider business mailing address

N10640 N PINE RD
TOMAHAWK WI
54487-9181
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-7700
  • Fax:
Mailing address:
  • Phone: 715-966-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2478-19
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17365-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: