Healthcare Provider Details

I. General information

NPI: 1790354090
Provider Name (Legal Business Name): MADELEINE GERMAINE PHILIPP PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 88TH AVE
KENOSHA WI
53144-7468
US

IV. Provider business mailing address

1515 N CASS ST APT 1
MILWAUKEE WI
53202-2057
US

V. Phone/Fax

Practice location:
  • Phone: 262-287-0090
  • Fax:
Mailing address:
  • Phone: 618-604-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15472-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: