Provider Demographics
NPI:1578036935
Name:BORDELON, MADELEINE AMELIE
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:AMELIE
Last Name:BORDELON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 REDWING BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-2466
Mailing Address - Country:US
Mailing Address - Phone:337-654-8491
Mailing Address - Fax:
Practice Address - Street 1:1714 REDWING BLUFF DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-2466
Practice Address - Country:US
Practice Address - Phone:337-654-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1289985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist