Active NPI
Madilyn Sue Slade, PT
- Physical Therapist
- Mesa, AZ
National Provider Identifier
1740488675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6903
- Practice address
- 1118 N Recker Rd
109
Mesa, AZ 85205-5504 - Phone
- (480) 833-2778
- Fax
- (480) 833-0232
- NPI assigned
- Jul 3, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6903 | AZ | Primary |
Addresses
Primary practice location
1118 N Recker Rd
109
Mesa, AZ 85205-5504
Mailing address
1118 N Recker Rd
109
Mesa, AZ 85205-5504
Phone (480) 833-2778
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 68-0659242 | Other | AZ | TAX ID |
| 6903 | Other | AZ | LICENSE |
Other names 1
- Miss Madilyn Sue Bosen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6903 | AZ | MD | Registered Respiratory Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wing Neurological Rehabilitation | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Phoenix, AZ
- NPI 1801840897
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414972800000",
"number": "1740488675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1118 N RECKER RD",
"address_2": "109",
"city": "MESA",
"state": "AZ",
"postal_code": "852055504",
"telephone_number": "480-833-2778",
"fax_number": "480-833-0232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1118 N RECKER RD",
"address_2": "109",
"city": "MESA",
"state": "AZ",
"postal_code": "852055504",
"telephone_number": "480-833-2778",
"fax_number": "480-833-0232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLADE",
"first_name": "MADILYN",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-03",
"last_updated": "2014-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "6903",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "68-0659242",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "6903",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MADILYN",
"last_name": "BOSEN",
"middle_name": "SUE",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.