Provider Demographics
NPI:1558243626
Name:GRAY, MADALYN (LMT)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 TOWER HILL DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5348
Mailing Address - Country:US
Mailing Address - Phone:920-495-2065
Mailing Address - Fax:
Practice Address - Street 1:725 HEARTLAND TRL STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1966
Practice Address - Country:US
Practice Address - Phone:608-455-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15754-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist