Healthcare Provider Details

I. General information

NPI: 1750215513
Provider Name (Legal Business Name): MADELAINE CAROL PALEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S LOCUST ST
MCCOMB MS
39648-4336
US

IV. Provider business mailing address

1040 CHESTER REEVES RD
MCCOMB MS
39648-9708
US

V. Phone/Fax

Practice location:
  • Phone: 601-248-9064
  • Fax:
Mailing address:
  • Phone: 601-248-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8182
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: