Provider Demographics
NPI:1437307840
Name:RIZZO, KELLIE MAUREEN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:MAUREEN
Last Name:RIZZO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:KELLIE
Other - Middle Name:MAUREEN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2350 OAKDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9702
Mailing Address - Country:US
Mailing Address - Phone:319-351-5437
Mailing Address - Fax:319-351-5432
Practice Address - Street 1:2350 OAKDALE BLVD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9702
Practice Address - Country:US
Practice Address - Phone:319-351-5437
Practice Address - Fax:319-351-5432
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027470-1225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist