Healthcare Provider Details

I. General information

NPI: 1033206370
Provider Name (Legal Business Name): CRISTINA RAYNE MADARANG-STOFIK MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTINA RAYNE BALLET MPT

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 E BELL RD STE 121
PHOENIX AZ
85022-6640
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-8441
  • Fax: 602-795-8447
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number20031
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberJ10001602
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11851
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: