Healthcare Provider Details

I. General information

NPI: 1811515893
Provider Name (Legal Business Name): MADELINE SCRIVNER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CONCORD PLAZA SHOPPING CTR
SAINT LOUIS MO
63128-1307
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-2990
  • Fax: 314-842-5162
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP004459T
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2020020228
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: