Provider Demographics
NPI:1407009988
Name:BIZZARRO, MICHELLE MARY (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARY
Last Name:BIZZARRO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20 PEACHTREE CT
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4616
Mailing Address - Country:US
Mailing Address - Phone:631-467-3700
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:59 HARRIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-3406
Practice Address - Country:US
Practice Address - Phone:518-669-9033
Practice Address - Fax:631-467-0928
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025455-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist