Individual
MADALYN IDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
811 HARTFORD PIKE, DAYVILLE, CT 06241-1716
(207) 520-9132
Mailing address
811 HARTFORD PIKE, DAYVILLE, CT 06241-1716
(207) 520-9132
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/10/2017
Last updated
07/21/2022
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