Provider Demographics
NPI:1609540467
Name:GAGNON, MADELINE M (DPT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:M
Last Name:GAGNON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N STATE ST APT 5009
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7244
Mailing Address - Country:US
Mailing Address - Phone:630-751-9289
Mailing Address - Fax:
Practice Address - Street 1:540 N STATE ST APT 5009
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7244
Practice Address - Country:US
Practice Address - Phone:630-751-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist