Provider Demographics
NPI:1780161018
Name:GEORGE, MADISON TAYLOR (PT)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:TAYLOR
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MADISON
Other - Middle Name:TAYLOR
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3300 CHANDLER RD STE 115
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-4909
Mailing Address - Country:US
Mailing Address - Phone:918-684-9999
Mailing Address - Fax:888-663-4223
Practice Address - Street 1:3300 CHANDLER RD STE 115
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4909
Practice Address - Country:US
Practice Address - Phone:918-684-9999
Practice Address - Fax:888-663-4223
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5440261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy