Provider Demographics
NPI:1538783758
Name:OAK, MADISON AUGUST (DPT)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:AUGUST
Last Name:OAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:AUGUST
Other - Last Name:HEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-1295
Mailing Address - Country:US
Mailing Address - Phone:805-458-8751
Mailing Address - Fax:
Practice Address - Street 1:4425 BERRY DR APT 3711
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9102
Practice Address - Country:US
Practice Address - Phone:805-458-8751
Practice Address - Fax:212-596-7133
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214727225100000X
CA300611225100000X
MD28630225100000X
NY045915225100000X
NJ40QA01926700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist