Basic Information
| Provider Information | |||||||||
| NPI: | 1013490226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLORENDO | ||||||||
| FirstName: | PRECILLA ANN | ||||||||
| MiddleName: | TORRES | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2705 MOON SHADOW DR NE | ||||||||
| Address2: | |||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871444144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053866377 | ||||||||
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| Practice Location | |||||||||
| Address1: | PARAGON REHABILITATION | ||||||||
| Address2: | 2701 CHESTNUT STATION COURT | ||||||||
| City: | LOIUSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003351060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2018 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT4244 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.