Provider Demographics
NPI:1538020946
Name:MADISON, NIKITA (LMT)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 1/2 W WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5242
Mailing Address - Country:US
Mailing Address - Phone:208-426-9200
Mailing Address - Fax:208-426-9300
Practice Address - Street 1:420 W MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7363
Practice Address - Country:US
Practice Address - Phone:208-426-9200
Practice Address - Fax:208-426-9300
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-4339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist