MEDICARE: CHRISTINE CRUZ VERDILLO P.T.

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	2251G0304X	Geriatric Physical Therapist	5776-024	WI

General Provider Information

NPI Number	:	1881861268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE CRUZ VERDILLO P.T.

Provider Business Mailing Address
First Line	:	8534 W MILL RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-1934
Country	:	US
Telephone Number	:	414-353-2300
Fax Number	:	414-353-2727

Provider Business Practice Location Address
First Line	:	8534 W MILL RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-1934
Country	:	US
Telephone Number	:	414-353-2300
Fax Number	:	414-353-2727

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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