Provider Demographics
NPI:1295386860
Name:PIAZZA, GEORGEANNA CHRISTINA (LMT)
Entity Type:Individual
Prefix:
First Name:GEORGEANNA
Middle Name:CHRISTINA
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 W ELM ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2036
Mailing Address - Country:US
Mailing Address - Phone:631-782-9049
Mailing Address - Fax:
Practice Address - Street 1:1386 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2842
Practice Address - Country:US
Practice Address - Phone:631-751-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist