Provider Demographics
NPI:1255959284
Name:DIRENZO, VICTORIA ROSE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:DIRENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 STANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1358
Mailing Address - Country:US
Mailing Address - Phone:610-331-4719
Mailing Address - Fax:
Practice Address - Street 1:962 WAYNE AVE STE L-D
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4433
Practice Address - Country:US
Practice Address - Phone:301-650-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist