Healthcare Provider Details

I. General information

NPI: 1417083924
Provider Name (Legal Business Name): MRS. GENEVIEVE DACOCO DUREMDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 30TH LANE EAST
BRANDENTON FL
34208-7384
US

IV. Provider business mailing address

4211 30TH LANE EAST
BRANDENTON FL
34208-7384
US

V. Phone/Fax

Practice location:
  • Phone: 941-751-7505
  • Fax: 941-753-6961
Mailing address:
  • Phone: 941-751-7505
  • Fax: 941-753-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT10601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: