Provider Demographics
NPI:1639235674
Name:DERCZO, LORRAINE JOAN (MPT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:JOAN
Last Name:DERCZO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SHUFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-7406
Mailing Address - Country:US
Mailing Address - Phone:828-894-0277
Mailing Address - Fax:828-894-0278
Practice Address - Street 1:465 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1235
Practice Address - Country:US
Practice Address - Phone:828-287-0999
Practice Address - Fax:828-287-0880
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21092225100000X
SC8669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist