Provider Demographics
NPI:1518038512
Name:AIZAGA, DANIZA (PT)
Entity Type:Individual
Prefix:
First Name:DANIZA
Middle Name:
Last Name:AIZAGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5024
Mailing Address - Country:US
Mailing Address - Phone:617-901-7486
Mailing Address - Fax:
Practice Address - Street 1:20 MILLTOWN RD
Practice Address - Street 2:SUITE 104A
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4344
Practice Address - Country:US
Practice Address - Phone:845-278-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007925225100000X
CA29498225100000X
NY028361-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist