Provider Demographics
NPI:1952687048
Name:CORDREY, RENEE (PT, CWS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CORDREY
Suffix:
Gender:F
Credentials:PT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N TAYLOR ST
Mailing Address - Street 2:THE JEFFERSON-- REHABILITATION DEPARTMENT
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 N TAYLOR ST
Practice Address - Street 2:THE JEFFERSON-- REHABILITATION DEPARTMENT
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1858
Practice Address - Country:US
Practice Address - Phone:703-516-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207197225100000X
DCPT871107225100000X
CAPT 20473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist