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General NPI Number Information
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NPI Number | 1053590125
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Entity Type | Individual
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Provider Name | LOURDES BERNADETTE VERDERA POTESTADES PT, DPT, OCS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 5 N LA PLATA CT STE 102
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City | LA PLATA
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State | MD
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Zip | 20646-5207
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Country | US
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Telephone | 301-609-5494
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Fax | 301-392-6109
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Provider Business Mailing Address
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Address Line | 4670 PRESTANCIA PL APT 102
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City | WALDORF
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State | MD
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Zip | 20602-4124
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Country | US
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Telephone | 443-538-2987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P11371
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23535
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License Number State | MD
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