Provider Demographics
NPI:1437464930
Name:IANNUZZI, LOUIS NICHOLAS (PT)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:NICHOLAS
Last Name:IANNUZZI
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 1:380 2ND AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5615
Mailing Address - Country:US
Mailing Address - Phone:646-387-6838
Mailing Address - Fax:
Practice Address - Street 1:15 UPTON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3107
Practice Address - Country:US
Practice Address - Phone:646-387-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0070521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist