Healthcare Provider Details

I. General information

NPI: 1720950538
Provider Name (Legal Business Name): MADISON LEIGH GILEAU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 OTROBANDO AVE
NORWICH CT
06360-2149
US

IV. Provider business mailing address

296 ROSS HILL RD
LISBON CT
06351-2826
US

V. Phone/Fax

Practice location:
  • Phone: 860-980-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014542
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: