Provider Demographics
NPI:1417083924
Name:DUREMDEZ, GENEVIEVE DACOCO
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:DACOCO
Last Name:DUREMDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 30TH LANE EAST
Mailing Address - Street 2:
Mailing Address - City:BRANDENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-7384
Mailing Address - Country:US
Mailing Address - Phone:941-751-7505
Mailing Address - Fax:941-753-6961
Practice Address - Street 1:4211 30TH LANE EAST
Practice Address - Street 2:
Practice Address - City:BRANDENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7384
Practice Address - Country:US
Practice Address - Phone:941-751-7505
Practice Address - Fax:941-753-6961
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2058AMedicare ID - Type Unspecified