Provider Demographics
NPI:1639326200
Name:AZZARITO, ANDREA M
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:AZZARITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 WATER VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03864-7268
Mailing Address - Country:US
Mailing Address - Phone:603-539-7511
Mailing Address - Fax:
Practice Address - Street 1:93 WATER VILLAGE RD
Practice Address - Street 2:
Practice Address - City:OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03864-7268
Practice Address - Country:US
Practice Address - Phone:603-539-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist