Provider Demographics
NPI:1154613156
Name:SADORRA, MADELEINE TANGLAO
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:TANGLAO
Last Name:SADORRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FOXGLOVE CT
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5323
Mailing Address - Country:US
Mailing Address - Phone:352-419-9040
Mailing Address - Fax:
Practice Address - Street 1:1 FOXGLOVE CT
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5323
Practice Address - Country:US
Practice Address - Phone:352-419-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist