Provider Demographics
NPI:1629507603
Name:MAY, MADELINE STRONG (DPT)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:STRONG
Last Name:MAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:ROSE
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 TYLER WAY
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847
Mailing Address - Country:US
Mailing Address - Phone:406-273-3730
Mailing Address - Fax:406-273-9088
Practice Address - Street 1:106 TYLER WAY
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847
Practice Address - Country:US
Practice Address - Phone:406-273-3730
Practice Address - Fax:406-273-9088
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-12963225100000X
MT12963261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT187-126-4879Medicaid