Provider Demographics
NPI:1184469900
Name:NAUGHTON, MADELINE LOUISE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:LOUISE
Last Name:NAUGHTON
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 1:731 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF LAKEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60014-5646
Mailing Address - Country:US
Mailing Address - Phone:815-353-6269
Mailing Address - Fax:
Practice Address - Street 1:1901 FRANK SCOTT PKWY E
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7342
Practice Address - Country:US
Practice Address - Phone:618-624-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.028391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist