Provider Demographics
NPI:1346288081
Name:GIANNONI, GEORGE J (PT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:GIANNONI
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 1:36 TWILIGHT DR
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-1212
Mailing Address - Country:US
Mailing Address - Phone:860-653-9075
Mailing Address - Fax:
Practice Address - Street 1:66 UNION SQ
Practice Address - Street 2:SUITE 204
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3040
Practice Address - Country:US
Practice Address - Phone:617-666-9600
Practice Address - Fax:617-666-9601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist