Healthcare Provider Details

I. General information

NPI: 1023861648
Provider Name (Legal Business Name): ANELISE MADJARIAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3994 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-9416
US

IV. Provider business mailing address

863 SPRING CIR APT 101
DEERFIELD BEACH FL
33441-7887
US

V. Phone/Fax

Practice location:
  • Phone: 954-360-7779
  • Fax: 561-395-6995
Mailing address:
  • Phone: 954-687-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT39747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: