Provider Demographics
NPI:1003064940
Name:MARZULLO, ROSINA ANN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ROSINA
Middle Name:ANN
Last Name:MARZULLO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-3601
Mailing Address - Country:US
Mailing Address - Phone:850-866-6734
Mailing Address - Fax:
Practice Address - Street 1:6015 HILLTOP AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-3601
Practice Address - Country:US
Practice Address - Phone:850-866-6734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18813225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18813OtherPTA LICENSE NUMBER