Provider Demographics
NPI:1003086877
Name:RIVIZZIANO, STEVE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:RIVIZZIANO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SWANSEA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206
Mailing Address - Country:US
Mailing Address - Phone:315-672-5063
Mailing Address - Fax:315-672-5461
Practice Address - Street 1:4050 MILTON AVENUE
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031
Practice Address - Country:US
Practice Address - Phone:315-672-5063
Practice Address - Fax:315-672-5461
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1C53692BMedicare PIN