Provider Demographics
NPI:1821298217
Name:VERDIDA, ANNA ROMINA KALAW (PT)
Entity Type:Individual
Prefix:
First Name:ANNA ROMINA
Middle Name:KALAW
Last Name:VERDIDA
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 1:1001 ISAAC CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5307
Mailing Address - Country:US
Mailing Address - Phone:626-216-4282
Mailing Address - Fax:
Practice Address - Street 1:220 WHITE PLAINS RD
Practice Address - Street 2:SUITE 550
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5837
Practice Address - Country:US
Practice Address - Phone:914-631-9020
Practice Address - Fax:914-631-9028
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01214800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist