Provider Demographics
NPI:1659548519
Name:CORDERO, RAYMOND DIZON (PT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:DIZON
Last Name:CORDERO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 MEADOWLARK LANE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-5013
Mailing Address - Country:US
Mailing Address - Phone:909-436-7639
Mailing Address - Fax:
Practice Address - Street 1:1820 MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-5013
Practice Address - Country:US
Practice Address - Phone:909-436-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist