Individual
CIARA GRACE MADERAZO TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
156 NW CALIFORNIA BLVD, PORT ST LUCIE, FL 34986-2492
(772) 871-7170
(772) 871-9330
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(866) 518-0283
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
011731
CT
225100000X
Physical Therapist
PT016488
GA
225100000X
Physical Therapist
Primary
PT42534
FL
Other
Enumeration date
09/27/2022
Last updated
03/23/2025
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