MEDICARE: MS. CLAUDIA MIRIAM GARDUNO MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1155660	TX

General Provider Information

NPI Number	:	1700812948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLAUDIA MIRIAM GARDUNO MPT

Provider Business Mailing Address
First Line	:	2320 MURCHISON DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79930-1106
Country	:	US
Telephone Number	:	915-533-1007
Fax Number	:

Provider Business Practice Location Address
First Line	:	6358 EDGEMERE BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-3517
Country	:	US
Telephone Number	:	915-562-8525
Fax Number	:	915-566-3889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	11/18/2009

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