Healthcare Provider Details

I. General information

NPI: 1578130126
Provider Name (Legal Business Name): MADELEINE CHRISTINA RUTH FOOTE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELEINE FULLER

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W MAIN ST
MOORE OK
73160-5105
US

IV. Provider business mailing address

117 W MAIN ST
MOORE OK
73160-5105
US

V. Phone/Fax

Practice location:
  • Phone: 405-237-9268
  • Fax: 405-543-0029
Mailing address:
  • Phone: 405-237-9268
  • Fax: 405-543-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5990
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5990
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: