Provider Demographics
NPI:1538876610
Name:TAITANO, MADISON NICHOLE AGUON (PT, DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICHOLE AGUON
Last Name:TAITANO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16649 W JENAN DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-6070
Mailing Address - Country:US
Mailing Address - Phone:443-676-7900
Mailing Address - Fax:
Practice Address - Street 1:7727 W DEER VALLEY RD STE 210
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2120
Practice Address - Country:US
Practice Address - Phone:623-208-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist