Provider Demographics
NPI:1144409855
Name:CENDANA-MALVAS, GERALDINE GRACE (RPT)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:GRACE
Last Name:CENDANA-MALVAS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14866 TAMIAMI TRL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2701
Mailing Address - Country:US
Mailing Address - Phone:941-423-7705
Mailing Address - Fax:941-423-7712
Practice Address - Street 1:14866 TAMIAMI TRL
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2701
Practice Address - Country:US
Practice Address - Phone:941-423-7705
Practice Address - Fax:941-423-7712
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLYO52QOtherBCBS
Y052QMedicare PIN