Provider Demographics
NPI:1710861265
Name:MARTIN, MADELYN PAIGE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:PAIGE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:MADELYN
Other - Middle Name:PAIGE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:785 RICHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-5718
Mailing Address - Country:US
Mailing Address - Phone:708-305-8327
Mailing Address - Fax:
Practice Address - Street 1:887 E WILMETTE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6495
Practice Address - Country:US
Practice Address - Phone:847-907-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.010478225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant