Provider Demographics
NPI:1437694163
Name:CANNIZZARO PHYSICAL THERAPY, PLC
Entity Type:Organization
Organization Name:CANNIZZARO PHYSICAL THERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LENA
Authorized Official - Middle Name:M CANNIZZARO
Authorized Official - Last Name:GOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:802-922-0079
Mailing Address - Street 1:8 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5713
Mailing Address - Country:US
Mailing Address - Phone:802-922-0079
Mailing Address - Fax:
Practice Address - Street 1:8 WHITE ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5713
Practice Address - Country:US
Practice Address - Phone:802-922-0079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0003496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty