Provider Demographics
NPI:1629221890
Name:GHIZZONI, KATHLEEN ANN (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:GHIZZONI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:14 IDA LN
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-4992
Mailing Address - Country:US
Mailing Address - Phone:518-356-8060
Mailing Address - Fax:518-357-2764
Practice Address - Street 1:14 IDA LN
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4992
Practice Address - Country:US
Practice Address - Phone:518-356-8060
Practice Address - Fax:518-357-2764
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009268-12251P0200X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No252Y00000XAgenciesEarly Intervention Provider Agency