Provider Demographics
NPI:1194434787
Name:KUMP, MADISON THERESA (ATC, SCAT, NREMT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:THERESA
Last Name:KUMP
Suffix:
Gender:F
Credentials:ATC, SCAT, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8960 WOODLARK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4543
Mailing Address - Country:US
Mailing Address - Phone:317-771-2661
Mailing Address - Fax:
Practice Address - Street 1:701 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1578
Practice Address - Country:US
Practice Address - Phone:317-771-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN146N00000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic