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Organization
KEITH R. MADONIA, P.A.
Active
Organization
KEITH R. MADONIA, P.A.
Active
Other names
Optimum Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH RYAN MADONIA P.T. (OWNER)
(305) 310-3702
Entity
Organization
Contact information
Practice address
2042 SW PROVIDENCE PL, PORT ST LUCIE, FL 34953-4385
(305) 310-3702
Mailing address
2042 SW PROVIDENCE PL, PORT ST LUCIE, FL 34953-4385
(305) 310-3702
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT19334
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IB393A
MEDICARE PTAN
FL
Enumeration date
11/03/2014
Last updated
05/01/2015
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