Provider Demographics
NPI:1699285593
Name:BARTNIKOWSKI, MADISON EVE (PT, DPT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:EVE
Last Name:BARTNIKOWSKI
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:DR
Other - First Name:MADISON
Other - Middle Name:EVE
Other - Last Name:TRUSCINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, LAT, ATC
Mailing Address - Street 1:1511 US HIGHWAY 59 SE STE A
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-3413
Mailing Address - Country:US
Mailing Address - Phone:218-681-0449
Mailing Address - Fax:218-325-4501
Practice Address - Street 1:1511 US HIGHWAY 59 SE STE A
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-3413
Practice Address - Country:US
Practice Address - Phone:218-681-0449
Practice Address - Fax:218-325-4501
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 261QP2000X, 390200000X
WAPT61172214261QP2000X
MN13434261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program