MEDICARE: MADELINE DAVOLT

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	2026008549	MO

General Provider Information

NPI Number	:	1700730249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE DAVOLT

Provider Business Mailing Address
First Line	:	120 SW GARDEN ST
Second Line	:
City	:	GRAIN VALLEY
State	:	MO
Zip	:	64029-9548
Country	:	US
Telephone Number	:	816-265-1170
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 HAINES
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1006
Country	:	US
Telephone Number	:	816-265-1170
Fax Number	:

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

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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Directions to “ MADELINE DAVOLT ” Practice Location

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