Provider Demographics
NPI:1336864883
Name:TERHUNE, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:TERHUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N HUMPHREYS ST STE A
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3027
Mailing Address - Country:US
Mailing Address - Phone:918-630-0025
Mailing Address - Fax:
Practice Address - Street 1:2501 N 4TH ST STE 6
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3700
Practice Address - Country:US
Practice Address - Phone:928-224-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-28337225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist