Provider Demographics
NPI:1225063654
Name:CANNIZZARO GOGLIA, LENA MARIA CANNIZZARO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:MARIA CANNIZZARO
Last Name:CANNIZZARO GOGLIA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5713
Mailing Address - Country:US
Mailing Address - Phone:802-863-3323
Mailing Address - Fax:802-863-3288
Practice Address - Street 1:8 WHITE ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5713
Practice Address - Country:US
Practice Address - Phone:802-863-3323
Practice Address - Fax:802-863-3288
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist