Provider Demographics
NPI:1487221578
Name:ORTEGA, MADISON MARIE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:MARIE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 HICKORY PL
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-3780
Mailing Address - Country:US
Mailing Address - Phone:707-490-8105
Mailing Address - Fax:
Practice Address - Street 1:74240 TALLASSEE HWY
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-5504
Practice Address - Country:US
Practice Address - Phone:334-514-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist