Provider Demographics
NPI:1871062646
Name:MADISON THERAPY & WELLNESS PLLC
Entity type:Organization
Organization Name:MADISON THERAPY & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:SEARCY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:850-464-0594
Mailing Address - Street 1:235 SW DADE ST STE B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-2363
Mailing Address - Country:US
Mailing Address - Phone:850-973-2929
Mailing Address - Fax:850-973-3939
Practice Address - Street 1:235 SW DADE ST STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2363
Practice Address - Country:US
Practice Address - Phone:850-973-2929
Practice Address - Fax:850-973-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102295299Medicaid