Provider Demographics
NPI:1982735866
Name:SCOTT MADSEN M.S.P.T. REHABILITATION, INC.
Entity type:Organization
Organization Name:SCOTT MADSEN M.S.P.T. REHABILITATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-775-9500
Mailing Address - Street 1:3075 N WINDSONG DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1208
Mailing Address - Country:US
Mailing Address - Phone:928-775-9500
Mailing Address - Fax:
Practice Address - Street 1:3075 N WINDSONG DR
Practice Address - Street 2:SUITE C
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1208
Practice Address - Country:US
Practice Address - Phone:928-775-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430819Medicaid
AZ430819Medicaid