MEDICARE: MARKO ANTHONY MEDINA PTA

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	225200000X	Physical Therapy Assistant	PTA19439	FL

General Provider Information

NPI Number	:	1790644235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARKO ANTHONY MEDINA PTA

Provider Business Mailing Address
First Line	:	1003 WESTWINDS DR
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-3841
Country	:	US
Telephone Number	:	863-350-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	1991 DAVENPORT BLVD
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-9201
Country	:	US
Telephone Number	:	863-679-3338
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ MARKO ANTHONY MEDINA PTA” Practice Location

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