Healthcare Provider Details

I. General information

NPI: 1376205823
Provider Name (Legal Business Name): MADELINE GEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18109 PRINCE PHILIP DR
OLNEY MD
20832-1519
US

IV. Provider business mailing address

13861 TRIADELPHIA MILL RD
DAYTON MD
21036-1235
US

V. Phone/Fax

Practice location:
  • Phone: 301-260-3280
  • Fax:
Mailing address:
  • Phone: 410-531-2586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5698
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: