Healthcare Provider Details

I. General information

NPI: 1366031924
Provider Name (Legal Business Name): MADALYNE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 GARFIELD AVE STE 200
PARKERSBURG WV
26101-3247
US

IV. Provider business mailing address

4303 10TH AVE APT 9
PARKERSBURG WV
26101-7820
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-6778
  • Fax:
Mailing address:
  • Phone: 681-209-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004344
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: