Provider Demographics
NPI:1093909897
Name:RIZZA, GARY NICHOLAS (MED, BS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:NICHOLAS
Last Name:RIZZA
Suffix:
Gender:M
Credentials:MED, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S PARK TER
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5351
Mailing Address - Country:US
Mailing Address - Phone:336-627-7778
Mailing Address - Fax:336-623-1919
Practice Address - Street 1:110 S PARK TER
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5351
Practice Address - Country:US
Practice Address - Phone:336-627-7778
Practice Address - Fax:336-623-1919
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03592255A2300X
NC8113552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer