Basic Information
| Provider Information | |||||||||
| NPI: | 1952687048 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CORDREY | ||||||||
| FirstName: | RENEE | ||||||||
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| Credential: | PT, CWS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 N TAYLOR ST | ||||||||
| Address2: | THE JEFFERSON-- REHABILITATION DEPARTMENT | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222031858 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 N TAYLOR ST | ||||||||
| Address2: | THE JEFFERSON-- REHABILITATION DEPARTMENT | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222031858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035169455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2011 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305207197 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT871107 | DC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT 20473 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.