Provider Demographics
NPI:1578883658
Name:OSANA, MADELEEN MAE ASILO (PT)
Entity Type:Individual
Prefix:
First Name:MADELEEN MAE
Middle Name:ASILO
Last Name:OSANA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 PINE WALK CT NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4450
Mailing Address - Country:US
Mailing Address - Phone:321-725-2405
Mailing Address - Fax:321-725-2406
Practice Address - Street 1:1326 MALABAR RD SE UNIT 234
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2502
Practice Address - Country:US
Practice Address - Phone:321-725-2405
Practice Address - Fax:321-725-2406
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist