Provider Demographics
NPI:1568720373
Name:SANZO, NICHOLAS (PTA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SANZO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WESTERN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5066
Mailing Address - Country:US
Mailing Address - Phone:518-869-6220
Mailing Address - Fax:518-869-6465
Practice Address - Street 1:1971 WESTERN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5066
Practice Address - Country:US
Practice Address - Phone:518-869-6220
Practice Address - Fax:518-869-6465
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001938-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant