Healthcare Provider Details

I. General information

NPI: 1710361936
Provider Name (Legal Business Name): DROZ REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 ATLANTIC AVE
COLONIAL HEIGHTS VA
23834-2901
US

IV. Provider business mailing address

3115 ATLANTIC AVE
COLONIAL HEIGHTS VA
23834-2901
US

V. Phone/Fax

Practice location:
  • Phone: 215-804-4624
  • Fax: 804-451-0535
Mailing address:
  • Phone: 215-804-4624
  • Fax: 804-451-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101256434
License Number StateVA

VIII. Authorized Official

Name: DIANA HERNANDEZ DROZDOWICZ
Title or Position: PHYSICIAN
Credential: MD
Phone: 215-840-4624