Healthcare Provider Details

I. General information

NPI: 1861072159
Provider Name (Legal Business Name): MADISON PAIGE DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 04/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 LAKE UNDERHILL RD STE 345
ORLANDO FL
32822-8209
US

IV. Provider business mailing address

1885 JEWELL AVE APT 369
WINTER PARK FL
32789-5587
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-8626
  • Fax:
Mailing address:
  • Phone: 561-827-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT36197
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: