Provider Demographics
NPI:1568733517
Name:ANDREOZZI, JOAN ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ANN
Last Name:ANDREOZZI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BRUNSWICK DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-5148
Mailing Address - Country:US
Mailing Address - Phone:401-332-6002
Mailing Address - Fax:
Practice Address - Street 1:114 BRUNSWICK DR
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-5148
Practice Address - Country:US
Practice Address - Phone:401-222-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8564172V00000X
RI00675225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI00675OtherSTATE
RI00675OtherRI LICENSE