Provider Demographics
NPI:1538134184
Name:ALTIZIO, SERGIO JOSE (PT)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:JOSE
Last Name:ALTIZIO
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 1:960 PLEASANT VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1803
Mailing Address - Country:US
Mailing Address - Phone:973-243-1177
Mailing Address - Fax:973-243-9077
Practice Address - Street 1:960 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1803
Practice Address - Country:US
Practice Address - Phone:973-243-1177
Practice Address - Fax:973-243-9077
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00326400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
094751DFAMedicare ID - Type Unspecified