Provider Demographics
NPI:1386625473
Name:MADTES, ROBERT O (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:O
Last Name:MADTES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 N CHURCH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5632
Mailing Address - Country:US
Mailing Address - Phone:336-274-7480
Mailing Address - Fax:336-274-8903
Practice Address - Street 1:1910 N CHURCH ST
Practice Address - Street 2:SUITE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5632
Practice Address - Country:US
Practice Address - Phone:336-274-7480
Practice Address - Fax:336-274-8903
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC250019Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE