Healthcare Provider Details

I. General information

NPI: 1871567446
Provider Name (Legal Business Name): JOSHUA K RENZI PT, MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 05/01/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 YORK ROAD SUITE 104
TOWSON MD
21204-7519
US

IV. Provider business mailing address

7402 YORK ROAD SUITE 104
TOWSON MD
21204-7519
US

V. Phone/Fax

Practice location:
  • Phone: 410-560-3931
  • Fax: 410-560-0877
Mailing address:
  • Phone: 410-560-3931
  • Fax: 410-560-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19295
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: