Provider Demographics
NPI:1053590125
Name:POTESTADES, LOURDES BERNADETTE VERDERA (PT, DPT, OCS)
Entity type:Individual
Prefix:MISS
First Name:LOURDES BERNADETTE
Middle Name:VERDERA
Last Name:POTESTADES
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 PRESTANCIA PL APT 102
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-4124
Mailing Address - Country:US
Mailing Address - Phone:443-538-2987
Mailing Address - Fax:
Practice Address - Street 1:5 N LA PLATA CT STE 102
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5207
Practice Address - Country:US
Practice Address - Phone:301-609-5494
Practice Address - Fax:301-392-6109
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11371225100000X
MD23535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist