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NPI Code Detail

MEDICARE: MADISON OLBERDING PT, DPT, ATC

MEDICARE: MADISON OLBERDING PT, DPT, ATC
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
12255A2300XAthletic Trainer
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1801377015
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON OLBERDING PT, DPT, ATC
Provider Business Mailing Address
First Line : 135 FOX HARBOR DR
Second Line :
City : TROY
State : OH
Zip : 45373-1088
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 750 CHESTNUT ST
Second Line :
City : GREENVILLE
State : OH
Zip : 45331-1312
Country : US
Telephone Number : 937-547-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2018
Last Update Date : 10/10/2022

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