=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720528086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON HOWARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2017
-----------------------------------------------------
Last Update Date | 01/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 MAINE ST
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66044-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-505-2712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1316 N 1750 RD
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66044-9193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 11-05662
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------