Provider Demographics
NPI:1922242171
Name:LANZILLO, ANGELA R (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:R
Last Name:LANZILLO
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 1:132 HATFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861
Mailing Address - Country:US
Mailing Address - Phone:401-935-2777
Mailing Address - Fax:
Practice Address - Street 1:132 HATFIELD ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-2956
Practice Address - Country:US
Practice Address - Phone:401-935-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA00634225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant