Provider Demographics
NPI:1922003425
Name:VERDEBOUT, NADINE MARIE (PT, MLT)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:MARIE
Last Name:VERDEBOUT
Suffix:
Gender:F
Credentials:PT, MLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 LONG BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-1960
Mailing Address - Country:US
Mailing Address - Phone:727-524-6162
Mailing Address - Fax:727-536-6006
Practice Address - Street 1:2480 E BAY DR
Practice Address - Street 2:STE B13
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2441
Practice Address - Country:US
Practice Address - Phone:727-535-6746
Practice Address - Fax:727-536-6006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT006784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1760ZMedicare ID - Type Unspecified