MEDICARE: MADELINE TAVINO

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	P21471	NC

General Provider Information

NPI Number	:	1851029425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE TAVINO

Provider Business Mailing Address
First Line	:	3708 FORESTVIEW RD STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2391
Country	:	US
Telephone Number	:	919-786-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3708 FORESTVIEW RD STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2391
Country	:	US
Telephone Number	:	919-786-7434
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	02/09/2026

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Directions to “ MADELINE TAVINO ” Practice Location

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