Organization
BACK IN THE GAME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MADONNA RENEE THOMAS PT (PHYSICAL THERAPIST/OWNER)
(812) 282-4263
Entity
Organization
Contact information
Practice address
2940 HOLMANS LN, STE. B, JEFFERSONVILLE, IN 47130-6911
(812) 282-4263
(812) 288-6441
Mailing address
1010 WILDWOOD LN, NEW ALBANY, IN 47150-5429
(812) 282-4263
(812) 288-6441
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002013A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000230208
ANTHEM
IN
05
—
200421930A
—
IN
01
—
DA7238
MEDICARE RAILROAD
IN
Enumeration date
10/03/2007
Last updated
01/07/2016
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