Provider Demographics
NPI:1598839375
Name:CLEDERA-BONA, IRIS MILAGROS (PT)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:MILAGROS
Last Name:CLEDERA-BONA
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 1:1694 BAYHILL DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1956
Mailing Address - Country:US
Mailing Address - Phone:727-459-4556
Mailing Address - Fax:
Practice Address - Street 1:1694 BAYHILL DR
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-1956
Practice Address - Country:US
Practice Address - Phone:727-459-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5690225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics