Provider Demographics
NPI:1558020230
Name:GERECKE, MADALYN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MADALYN
Middle Name:
Last Name:GERECKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:MADALYN
Other - Middle Name:
Other - Last Name:AUBUCHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:119 WATSON PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1962
Mailing Address - Country:US
Mailing Address - Phone:314-961-3787
Mailing Address - Fax:314-961-0974
Practice Address - Street 1:119 WATSON PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1962
Practice Address - Country:US
Practice Address - Phone:314-961-3787
Practice Address - Fax:314-961-0974
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210481922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic