MEDICARE: MADELEINE DEVOL PT, DPT, OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1293121	TX

General Provider Information

NPI Number	:	1174049076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEINE DEVOL PT, DPT, OCS

Provider Business Mailing Address
First Line	:	700 TOWN AND COUNTRY BLVD STE 2490
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-3945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 TOWN AND COUNTRY BLVD STE 2490
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-3945
Country	:	US
Telephone Number	:	832-658-3150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	10/28/2021

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