Active NPI
Nicholas James Derenzis
- Physical Therapist
- Independence, VA
National Provider Identifier
1720476757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 60386876
- Practice address
- 400 S Independence Ave
Independence, VA 24348 - Phone
- (276) 773-0303
- NPI assigned
- Dec 29, 2014
- Last updated
- Jul 25, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305205303 | VA | |
| Physical Therapist | 225100000X | PT003561 | WV | |
| Physical Therapist | 225100000X | PT 60386876 | WA | Primary |
Addresses
Primary practice location
400 S Independence Ave
Independence, VA 24348
Mailing address
5193 Waddletown Rd
Bland, VA 24315-4710
Other practice location 1
451 Westcliffe Blvd
Apt G351
Richland, WA 99352-9315
Phone (570) 856-0313
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305205303 | VA | MD | Physical Therapist |
| PT 60386876 | WA | MD | Physical Therapist |
| PT003561 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532476800000",
"number": "1720476757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5193 WADDLETOWN RD",
"city": "BLAND",
"state": "VA",
"postal_code": "243154710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S INDEPENDENCE AVE",
"city": "INDEPENDENCE",
"state": "VA",
"postal_code": "24348",
"telephone_number": "276-773-0303"
}
],
"practiceLocations": [
{
"address_1": "451 Westcliffe Blvd",
"address_2": "APT G351",
"address_purpose": "LOCATION",
"city": "Richland",
"state": "WA",
"postal_code": "993529315",
"country_code": "US",
"telephone_number": "570-856-0313",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DERENZIS",
"first_name": "NICHOLAS",
"middle_name": "JAMES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-29",
"last_updated": "2018-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305205303",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "PT003561",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT 60386876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Independence, VA
- Susan Dawn Childress Worrell, PT
- Holly Luann Collins, LPC
- Commonwealth of Virginia State Board of Health (Grayson County Health Department)
- Booby Neal Cox, DDS.
- Mary Elizabeth Dalton
- Julianna Marie Digiacomo, COTA
- DLP Twin County Physician Practices LLC (Independence Family Care Center)
- DLP Twin County Physician Practices LLC (Twin County Family Care Center - Independence)
- Karl Alan Fauble, PTA
- Lisa Funk, LPTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.