Provider Demographics
NPI:1578130126
Name:FOOTE, MADELEINE CHRISTINA RUTH (PT)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:CHRISTINA RUTH
Last Name:FOOTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5105
Mailing Address - Country:US
Mailing Address - Phone:405-237-9268
Mailing Address - Fax:405-543-0029
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5105
Practice Address - Country:US
Practice Address - Phone:405-237-9268
Practice Address - Fax:405-543-0029
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OK59902251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty