Provider Demographics
NPI:1083136873
Name:DERENZO, CATHERINE ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ANN
Last Name:DERENZO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6042 HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-2927
Mailing Address - Country:US
Mailing Address - Phone:239-595-0991
Mailing Address - Fax:
Practice Address - Street 1:5020 TAMIAMI TRL N STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2838
Practice Address - Country:US
Practice Address - Phone:239-261-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist