Provider Demographics
NPI:1104593151
Name:MADRONA PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:MADRONA PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-212-3620
Mailing Address - Street 1:4701 S 19TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1199
Mailing Address - Country:US
Mailing Address - Phone:253-212-3620
Mailing Address - Fax:253-301-2088
Practice Address - Street 1:4701 S 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1199
Practice Address - Country:US
Practice Address - Phone:253-212-3620
Practice Address - Fax:253-301-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty