Healthcare Provider Details

I. General information

NPI: 1780517169
Provider Name (Legal Business Name): MADISON PARKER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4887 MEXICO RD
SAINT PETERS MO
63376-2577
US

IV. Provider business mailing address

2427 CHURCHILL CT
COLUMBIA MO
65201-3354
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-1036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026023432
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: