Provider Demographics
NPI:1801881735
Name:TORDECILLAS, ROSEVIMINDA (PT)
Entity type:Individual
Prefix:MS
First Name:ROSEVIMINDA
Middle Name:
Last Name:TORDECILLAS
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 1:25351 TETHER LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5917
Mailing Address - Country:US
Mailing Address - Phone:941-585-8408
Mailing Address - Fax:941-625-1970
Practice Address - Street 1:21234 OLEAN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6721
Practice Address - Country:US
Practice Address - Phone:941-625-0555
Practice Address - Fax:941-625-1970
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY076EOtherBCBS
FLU1603XMedicare ID - Type Unspecified