Provider Demographics
NPI:1003385824
Name:PULZELLO, DONALD BENIDETO (PTA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:BENIDETO
Last Name:PULZELLO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5485 E LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-1066
Mailing Address - Country:US
Mailing Address - Phone:352-220-4748
Mailing Address - Fax:
Practice Address - Street 1:1550 KILLINGSWORTH WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-2175
Practice Address - Country:US
Practice Address - Phone:352-653-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27350225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant