Provider Demographics
NPI:1184919391
Name:FLORENDO, MARIE ANN
Entity type:Individual
Prefix:
First Name:MARIE ANN
Middle Name:
Last Name:FLORENDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE ANN
Other - Middle Name:
Other - Last Name:BALLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BRIAR CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-3900
Mailing Address - Country:US
Mailing Address - Phone:302-249-6673
Mailing Address - Fax:
Practice Address - Street 1:4 BRIAR CT
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-3900
Practice Address - Country:US
Practice Address - Phone:302-249-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1184919391Medicaid
DE2782958OtherBC BS DE
DE2782958OtherBC BS DE