Provider Demographics
NPI:1720194806
Name:DELORENZO, JENNIFER RU (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RU
Last Name:DELORENZO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:USCHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6911 STONEYBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1346
Mailing Address - Country:US
Mailing Address - Phone:703-859-3415
Mailing Address - Fax:703-842-8566
Practice Address - Street 1:301 N FAIRFAX ST STE 107
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2633
Practice Address - Country:US
Practice Address - Phone:703-859-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC142243YXPMedicare PIN