Provider Demographics
NPI:1629604905
Name:FAZZINO, LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:FAZZINO
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:CORA
Mailing Address - Street 2:136 WEST MAIN ST
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052
Mailing Address - Country:US
Mailing Address - Phone:860-801-6171
Mailing Address - Fax:860-826-4765
Practice Address - Street 1:CORA
Practice Address - Street 2:136 WEST MAIN ST
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-801-6171
Practice Address - Fax:860-826-4765
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist