Individual
MA LOURDES MADERAZO TADLIP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
616 WADE AVE, RALEIGH, NC 27605-1237
(919) 828-6251
Mailing address
616 WADE AVE, RALEIGH, NC 27605-1237
(919) 828-6251
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
11455
NC
Other
Enumeration date
06/20/2020
Last updated
06/20/2020
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