Individual
MRS. MADISON GRACE PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
7580 CLARINGTON CV, SOUTHAVEN, MS 38671-5657
(901) 259-1600
(901) 259-1698
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5754
(901) 259-1973
(901) 259-7637
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA7197
MS
Other
Enumeration date
08/12/2021
Last updated
11/14/2023
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