Provider Demographics
NPI:1093716144
Name:PAZZAGLIA, ANTHONY MARIANO (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MARIANO
Last Name:PAZZAGLIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222342
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93922-2342
Mailing Address - Country:US
Mailing Address - Phone:831-372-3579
Mailing Address - Fax:831-372-3779
Practice Address - Street 1:5 HARRIS CT
Practice Address - Street 2:BUILDING T, SUITE 102
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5750
Practice Address - Country:US
Practice Address - Phone:831-372-3579
Practice Address - Fax:831-372-3779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23205OtherLICENSE
11368096OtherCAQH PROVIDER ID
CA23205OtherLICENSE
CA595994Medicare UPIN