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General NPI Number Information
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NPI Number | 1811515893
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Entity Type | Individual
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Provider Name | MADELINE SCRIVNER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 107 CONCORD PLAZA SHOPPING CTR
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City | SAINT LOUIS
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State | MO
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Zip | 63128-1307
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Country | US
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Telephone | 314-842-2990
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Fax | 314-842-5162
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 630-575-1980
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Fax | 630-928-5080
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP004459T
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2020020228
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License Number State | MO
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