MEDICARE: ANA MARIA MADRID PT

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	1086791	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T4087	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1891704532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA MARIA MADRID PT

Provider Business Mailing Address
First Line	:	2310 INTERSTATE 20 W
Second Line	:	SUITE 204
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1677
Country	:	US
Telephone Number	:	817-466-7276
Fax Number	:	817-466-7286

Provider Business Practice Location Address
First Line	:	2310 INTERSTATE 20 W
Second Line	:	SUITE 204
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1677
Country	:	US
Telephone Number	:	817-466-7276
Fax Number	:	817-466-7286

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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