Provider Demographics
NPI:1194502005
Name:VERSAGE, MADELINE FAITH
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:FAITH
Last Name:VERSAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2005
Mailing Address - Country:US
Mailing Address - Phone:609-713-8318
Mailing Address - Fax:
Practice Address - Street 1:3800 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4146
Practice Address - Country:US
Practice Address - Phone:803-764-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCP042668T225100000X
GACP027979T225100000X
NJ40QA02208700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist