MEDICARE: BENJAMIN MADRID

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	PT-2025-0333	NM

General Provider Information

NPI Number	:	1609731728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MADRID

Provider Business Mailing Address
First Line	:	11701 FOX POINT AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1916
Country	:	US
Telephone Number	:	720-312-1604
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 FOX POINT AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1916
Country	:	US
Telephone Number	:	720-312-1604
Fax Number	:

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

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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Directions to “ BENJAMIN MADRID ” Practice Location

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