MEDICARE: ALEXIS MADRAZO DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40538	FL

General Provider Information

NPI Number	:	1083419428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS MADRAZO DPT

Provider Business Mailing Address
First Line	:	2466 TAYLOR ST APT 4C
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2466 TAYLOR ST APT 4C
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4342
Country	:	US
Telephone Number	:	407-883-4876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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