Provider Demographics
NPI:1114483195
Name:STORY, MADELEINE MARGARET (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:MARGARET
Last Name:STORY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:MARGARET
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:489 WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-5709
Mailing Address - Country:US
Mailing Address - Phone:774-696-8309
Mailing Address - Fax:508-721-0100
Practice Address - Street 1:489 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-5709
Practice Address - Country:US
Practice Address - Phone:774-696-8309
Practice Address - Fax:508-721-0100
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027370225100000X
25541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist