Provider Demographics
NPI:1588348676
Name:ORTON, MADISON AMELIA (DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:AMELIA
Last Name:ORTON
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 1:1600 RONALD REAGAN BLVD UNIT 9210
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6272
Mailing Address - Country:US
Mailing Address - Phone:971-678-5585
Mailing Address - Fax:
Practice Address - Street 1:477 PROMINENCE CT STE 200
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6377
Practice Address - Country:US
Practice Address - Phone:401-216-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist