Provider Demographics
NPI:1528796398
Name:BURBRIDGE, MADISYN (DPT)
Entity type:Individual
Prefix:
First Name:MADISYN
Middle Name:
Last Name:BURBRIDGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 SLATER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4722
Mailing Address - Country:US
Mailing Address - Phone:913-633-8914
Mailing Address - Fax:
Practice Address - Street 1:12626 LAMPLIGHTER SQUARE SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2746
Practice Address - Country:US
Practice Address - Phone:314-842-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022030862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist