Provider Demographics
NPI:1023841970
Name:MADISON VALLEY PHYSICAL THERAPY
Entity type:Organization
Organization Name:MADISON VALLEY PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELCEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:214-934-5486
Mailing Address - Street 1:275 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-9146
Mailing Address - Country:US
Mailing Address - Phone:214-934-5486
Mailing Address - Fax:
Practice Address - Street 1:10 SUNRISE LOOP
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-9054
Practice Address - Country:US
Practice Address - Phone:214-934-5486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-24
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy