MEDICARE: ASHLYN MADSEN

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	7767	SC

General Provider Information

NPI Number	:	1942682497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLYN MADSEN

Provider Business Mailing Address
First Line	:	2807 AUGUSTA ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-2045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 GROVE RD
Second Line	:	SUITE 2A
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4660
Country	:	US
Telephone Number	:	864-233-5128
Fax Number	:	864-271-2599

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/22/2015

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Directions to “ ASHLYN MADSEN ” Practice Location

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