Basic Information
| Provider Information | |||||||||
| NPI: | 1265967160 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MADRID | ||||||||
| FirstName: | MAYLIN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6917 SEA CORAL DR | ||||||||
| Address2: | APT 104 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328218024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863166143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5787 VINELAND RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328197804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073543906 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2017 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA 26497 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.