MEDICARE: MADISON MOORE

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	42119	FL

General Provider Information

NPI Number	:	1831920222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON MOORE

Provider Business Mailing Address
First Line	:	4020 PARK ST N STE 101
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4030
Country	:	US
Telephone Number	:	727-388-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 PARK ST N STE 101
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4030
Country	:	US
Telephone Number	:	727-388-4688
Fax Number	:

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

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

Similar Medicare Providers

1235397944 — MRS. MELBA JEAN THOMPSON R.N.
Practice Location Address:

4020 PARK ST N , SUITE 103
SAINT PETERSBURG, FL
33709-4030

Practice Phone: 727-345-8614
Practice Fax: 727-345-9319

1962013276 — GINA NGUYEN
Practice Location Address:

4020 PARK ST N STE 101
ST PETERSBURG, FL
33709-4030

Practice Phone: 727-388-4688
Practice Fax: 727-388-6887

1023736550 — DKB HEALTH LLC FYZICAL THERAPY AND BALANCE CENTER
Practice Location Address:

4020 PARK ST N STE 101
ST PETERSBURG, FL
33709-4030

Practice Phone: 727-388-4688
Practice Fax: 727-388-6887

1578256152 — CASSANDRA MARIE KANIA DPT
Practice Location Address:

4020 PARK ST N STE 101
ST PETERSBURG, FL
33709-4030

Practice Phone: 727-388-4688
Practice Fax:

1114607678 — HAILEY JORDAN ROBERSON
Practice Location Address:

4020 PARK ST N STE 101
ST PETERSBURG, FL
33709-4030

Practice Phone: 727-388-4688
Practice Fax:

1609667062 — BARBARA LAZ PT
Practice Location Address:

4020 PARK ST N STE 101
SAINT PETERSBURG, FL
33709-4030

Practice Phone: 727-388-4688
Practice Fax: 727-388-6887

Directions to “ MADISON MOORE ” 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.