Victor Derienzo, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 21246 Issued in FL

Practice address

14444 Beach Blvd
Jacksonville, FL 32250-2079

Phone

(904) 858-7510

Fax

(904) 858-7540

NPI assigned

Feb 7, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477693588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13069 SIR ROGERS CT S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241611",
            "telephone_number": "904-858-7514",
            "fax_number": "904-858-7540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14444 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322502079",
            "telephone_number": "904-858-7510",
            "fax_number": "904-858-7540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERIENZO",
        "first_name": "VICTOR",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 21246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89047660008",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derash Inc (Integrity Home Health Care)
• Christopher Townsend Deray, CRNA
• Casey Derderian, PHARMD
• Salem Isabella Derdock
• Anne Marie Derienzo, PT
• James Derisse
• Anne Dyna Derival, LCSW
• Michaela Annis Derival, LPN
• Jeltsje Willemien Derksen, PT
• Dermatology Group of Florida PA

• Physical Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.