Provider Demographics
NPI:1699485946
Name:MATHES, MADISON KAY (DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:KAY
Last Name:MATHES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:KAY
Other - Last Name:FARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3500 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8676
Mailing Address - Country:US
Mailing Address - Phone:515-239-3100
Mailing Address - Fax:
Practice Address - Street 1:3500 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8676
Practice Address - Country:US
Practice Address - Phone:515-239-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist