Provider Demographics
NPI:1992535264
Name:MCFADDEN, ANTHONY M
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:MCFADDEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W IRONWOOD DR STE 202
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4903
Mailing Address - Country:US
Mailing Address - Phone:208-601-6038
Mailing Address - Fax:
Practice Address - Street 1:8468 N WAYNE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-6025
Practice Address - Country:US
Practice Address - Phone:208-601-6038
Practice Address - Fax:208-664-1226
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3061379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist