Provider Demographics
NPI:1992337398
Name:GREAZEL, MADISON ANN (DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ANN
Last Name:GREAZEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ANN
Other - Last Name:HAGEDORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9109
Mailing Address - Fax:515-643-9138
Practice Address - Street 1:307 E SCENIC VALLEY AVE STE 300
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-4865
Practice Address - Country:US
Practice Address - Phone:515-643-9109
Practice Address - Fax:515-643-9138
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
IA118435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer