MEDICARE: MADISON SEYMOUR DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1053157271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON SEYMOUR DPT

Provider Business Mailing Address
First Line	:	12840 RIDGEWOOD RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-2986
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 E KLATT RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3665
Country	:	US
Telephone Number	:	907-245-1245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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