Individual provider Active NPI

Madonna Nacole Howerton-Bradley, PT

  • Physical Therapist
  • Jackson, TN
National Provider Identifier
1437213147
Registry record updated Sep 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7453 Issued in TN
Practice address
176W University Pkwy C
Jackson, TN 38305-1618
Phone
(731) 660-6915
Fax
(731) 668-4557
NPI assigned
Dec 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 7453 TN Primary

Addresses

Primary practice location

176W University Pkwy C
Jackson, TN 38305-1618

Mailing address

176W University Pkwy C
Jackson, TN 38305-1618
Phone (731) 660-6915

Other identifiers 1

IdentifierTypeStateIssuer
Q000202MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111215000573 TN Practitioner - Physical Therapist in Private Practice 2769442482 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Patterson Physical Therapy LLCGroup PAC ID 8022259878, 8 clinicians

Practice addresses (Care Compare)

176 W University Pkwy
Suite E F
Jackson, TN 38305-1618
Phone (731) 300-4950

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7453TNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Patterson Physical Therapy LLC Physical Therapist CurrentSince May 1, 2022 Accepting new patients
Kerry D. Friesen, M.D. PC Past Accepting new patients
Cabot Physical Therapy Physical Therapist PastSince Dec 15, 2009 Accepting new patients

Locations

176 W University Pkwy
Ste C
Jackson, TN 38305
Phone (731) 660-6915

176 W University Pkwy
Ste Ef
Jackson, TN 38305
Phone (731) 300-4950

400 US Highway 45 W
Three Way, TN 38343
Phone (731) 784-7771

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443052800000",
    "number": "1437213147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176W UNIVERSITY PKWY C",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051618",
            "telephone_number": "731-660-6915",
            "fax_number": "731-668-4557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176W UNIVERSITY PKWY C",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051618",
            "telephone_number": "731-660-6915",
            "fax_number": "731-668-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOWERTON-BRADLEY",
        "first_name": "MADONNA",
        "middle_name": "NACOLE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2015-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "7453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q000202",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.