Provider Demographics
NPI:1184461543
Name:SANTA MARIA, MADISON NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:SANTA MARIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10426 SW STRATTON DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2318
Mailing Address - Country:US
Mailing Address - Phone:954-647-8097
Mailing Address - Fax:
Practice Address - Street 1:1705 17TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3641
Practice Address - Country:US
Practice Address - Phone:772-562-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA33591225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant