MEDICARE: JANIS LYNN VERDE

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	PT13611	FL
2	2251X0800X	Orthopedic Physical Therapist	PT13611	FL

General Provider Information

NPI Number	:	1194950923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIS LYNN VERDE

Provider Business Mailing Address
First Line	:	PO BOX 551330
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33355-1330
Country	:	US
Telephone Number	:	305-876-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 E ATLANTIC BLVD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4939
Country	:	US
Telephone Number	:	305-876-9004
Fax Number	:

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

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	05/22/2009

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