MEDICARE: IRENE V VERDEFLOR

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	PT-2024-0048	NM
2	225200000X	Physical Therapy Assistant	2093639	TX

General Provider Information

NPI Number	:	1588909204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE V VERDEFLOR

Provider Business Mailing Address
First Line	:	613 W 2ND ST STE 1-5
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-4671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 W 2ND ST STE 1-5
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-4671
Country	:	US
Telephone Number	:	575-840-3879
Fax Number	:	866-337-2718

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

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	02/15/2024

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Directions to “ IRENE V VERDEFLOR ” Practice Location

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