MEDICARE: AMPARO MADEIRA

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	10378	FL

General Provider Information

NPI Number	:	1356879019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMPARO MADEIRA

Provider Business Mailing Address
First Line	:	11807 ROSSMAYNE DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5658
Country	:	US
Telephone Number	:	813-892-4208
Fax Number	:	813-671-0861

Provider Business Practice Location Address
First Line	:	4144 N ARMENIA AVE STE 230
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6447
Country	:	US
Telephone Number	:	813-872-8566
Fax Number	:

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

Provider Enumeration Date	:	05/25/2017
Last Update Date	:	05/25/2017

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Directions to “ AMPARO MADEIRA ” Practice Location

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