Provider Demographics
NPI:1578789699
Name:FLORENDO, GLADYS FERNANDEZ (PT)
Entity Type:Individual
Prefix:MISS
First Name:GLADYS
Middle Name:FERNANDEZ
Last Name:FLORENDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4624
Mailing Address - Country:US
Mailing Address - Phone:201-993-4136
Mailing Address - Fax:
Practice Address - Street 1:945 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4624
Practice Address - Country:US
Practice Address - Phone:201-993-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007743OtherPHYSICAL THERAPY LICENSE
NY026629OtherPHYSICAL THERAPY LICENSE