Provider Demographics
NPI:1902379902
Name:PISANI, WILLIAM VITO (PTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VITO
Last Name:PISANI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:VITO
Other - Last Name:PISANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-2919
Mailing Address - Country:US
Mailing Address - Phone:475-313-8109
Mailing Address - Fax:
Practice Address - Street 1:3 HICKORY LN
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2919
Practice Address - Country:US
Practice Address - Phone:475-313-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1928225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant