Provider Demographics
NPI:1811488547
Name:BORZELLECA, GRETCHEN E (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:E
Last Name:BORZELLECA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 BRYN MAWR RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6604
Mailing Address - Country:US
Mailing Address - Phone:804-285-2405
Mailing Address - Fax:
Practice Address - Street 1:1000 WINSTON CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-5129
Practice Address - Country:US
Practice Address - Phone:804-541-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist