MEDICARE: MADELEEN MAE ASILO OSANA P.T.

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	225100000X	Physical Therapist	25527	FL

General Provider Information

NPI Number	:	1578883658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEEN MAE ASILO OSANA P.T.

Provider Business Mailing Address
First Line	:	919 PINE WALK CT NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4450
Country	:	US
Telephone Number	:	321-725-2405
Fax Number	:	321-725-2406

Provider Business Practice Location Address
First Line	:	1326 MALABAR RD SE UNIT 234
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-2502
Country	:	US
Telephone Number	:	321-725-2405
Fax Number	:	321-725-2406

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

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/10/2010

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