National Provider Identifier
Madison Antionette Boutureira
Madison Antionette Boutureira is listed in the NPPES registry with a primary specialty of Athletic Trainer in Ithaca, NY and a listed phone number of (914) 874-6296.
Profile Overview
- NPI
- 1154889590
- Provider Type
- Individual
- Primary Specialty
- Athletic Trainer
- Enumeration Date
- March 05, 2019
- Last Updated
- March 05, 2019
Practice Location
- 953 Danby RD
- Ithaca, NY 14850-7000
Phone: (914) 874-6296
Specialties
- Athletic Trainer (2255A2300X)
- Student in an Organized Health Care Education/Training Program (390200000X)
Full Record
- NPI
- 1154889590
- Entity Type
- Individual
- Last Name
- Boutureira
- First Name
- Madison
- Middle Name
- Antionette
- Mailing Street Address
- 953 Danby RD
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-7000
- Mailing Country
- US
- Mailing Phone
- (914) 874-6296
- Practice Street Address
- 953 Danby RD
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-7000
- Practice Country
- US
- Practice Phone
- (914) 874-6296
- Enumeration Date
- March 05, 2019
- Last Updated
- March 05, 2019
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Athletic Trainer (2255A2300X), Student in an Organized Health Care Education/Training Program (390200000X)