Healthcare Provider Details

I. General information

NPI: 1104102433
Provider Name (Legal Business Name): MADELINE J HAMILTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE J CLINE DPT

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SAGAMORE RD
EXCELSIOR SPRINGS MO
64024-3006
US

IV. Provider business mailing address

711 SAGAMORE RD
EXCELSIOR SPRINGS MO
64024-3006
US

V. Phone/Fax

Practice location:
  • Phone: 816-824-3436
  • Fax:
Mailing address:
  • Phone: 816-824-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2010024961
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: