MEDICARE: KEREN MADRIZ

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	225700000X	Massage Therapist	MA79519	FL

General Provider Information

NPI Number	:	1528790573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEREN MADRIZ

Provider Business Mailing Address
First Line	:	2445 S VOLUSIA AVE STE C4
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7626
Country	:	US
Telephone Number	:	407-690-7696
Fax Number	:	407-610-0287

Provider Business Practice Location Address
First Line	:	2445 S VOLUSIA AVE STE C4
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7626
Country	:	US
Telephone Number	:	407-690-7696
Fax Number	:	407-610-0287

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

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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Directions to “ KEREN MADRIZ ” Practice Location

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