Basic Information
| Provider Information | |||||||||
| NPI: | 1609857796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADTES AUGHENBAUGH PHYSICAL THERAPY SERVICES | ||||||||
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| OtherOrganizationName: | PHYSICAL THERAPY & SPORTS REHABILITATION CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 N CHURCH ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274055632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747480 | ||||||||
| FaxNumber: | 3362748903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 N CHURCH ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274055632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747480 | ||||||||
| FaxNumber: | 3362748903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VARNEY | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3362747480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.