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NPI Code Detail

MEDICARE: CIARA GRACE MADERAZO TAN

MEDICARE: CIARA GRACE MADERAZO TAN
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
1225100000XPhysical TherapistPT016488GA
2225100000XPhysical TherapistPT42534FL
3225100000XPhysical Therapist011731CT

General Provider Information

NPI Number : 1528782158
Entity Type Code : Individual
Provider Name (Legal Business Name) : CIARA GRACE MADERAZO TAN
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number : 866-518-0283
Fax Number :
Provider Business Practice Location Address
First Line : 156 NW CALIFORNIA BLVD
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34986-2492
Country : US
Telephone Number : 772-871-7170
Fax Number : 772-871-9330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2022
Last Update Date : 03/23/2025

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Directions to “ CIARA GRACE MADERAZO TAN ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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