Provider Demographics
NPI:1861707226
Name:RENZI, GABRIELE (PT)
Entity type:Individual
Prefix:
First Name:GABRIELE
Middle Name:
Last Name:RENZI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4576
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4576
Mailing Address - Country:US
Mailing Address - Phone:336-629-6397
Mailing Address - Fax:336-629-6939
Practice Address - Street 1:640 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5320
Practice Address - Country:US
Practice Address - Phone:336-623-0975
Practice Address - Fax:336-623-0977
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6264225100000X
NC12793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist