Provider Demographics
NPI:1114155017
Name:VERDEFLOR, LAURENCE BAGAYAS (RPT)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:BAGAYAS
Last Name:VERDEFLOR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 WESCOTT LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5615
Mailing Address - Country:US
Mailing Address - Phone:407-461-9452
Mailing Address - Fax:407-951-5882
Practice Address - Street 1:1535 WESCOTT LOOP
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5615
Practice Address - Country:US
Practice Address - Phone:407-461-9452
Practice Address - Fax:407-951-5882
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist