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NPI Code Detail

MEDICARE: MADELINE DELAY GIFFORD PTA

MEDICARE: MADELINE DELAY GIFFORD PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2020036393MO

General Provider Information

NPI Number : 1750982088
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE DELAY GIFFORD PTA
Provider Business Mailing Address
First Line : 303 NEPUTE ST
Second Line :
City : MARYVILLE
State : IL
Zip : 62062-6628
Country : US
Telephone Number : 618-263-7873
Fax Number :
Provider Business Practice Location Address
First Line : 4624 LANSDOWNE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63116-1523
Country : US
Telephone Number : 314-351-6888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2020
Last Update Date : 11/03/2020

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Directions to “ MADELINE DELAY GIFFORD PTA” Practice Location

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