MEDICARE: MADISON ROSE SMITH PT, 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	CP032994T	AZ

General Provider Information

NPI Number	:	1790381291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON ROSE SMITH PT, DPT

Provider Business Mailing Address
First Line	:	313 PADDOCK DR
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-3847
Country	:	US
Telephone Number	:	864-350-2129
Fax Number	:

Provider Business Practice Location Address
First Line	:	25101 N LAKE PLEASANT PKWY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1386
Country	:	US
Telephone Number	:	623-471-5550
Fax Number	:

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

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	10/15/2024

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