Provider Demographics
NPI:1114539889
Name:MYERS, MADISON (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 SCOTCH HALL WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4887
Mailing Address - Country:US
Mailing Address - Phone:336-870-9166
Mailing Address - Fax:
Practice Address - Street 1:111 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4853
Practice Address - Country:US
Practice Address - Phone:910-892-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP197962251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics