Provider Demographics
NPI:1942264064
Name:PRINZIVALLI, JOHN L (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:PRINZIVALLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31 HALL DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002
Mailing Address - Country:US
Mailing Address - Phone:413-256-8561
Mailing Address - Fax:866-644-0869
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:866-644-0869
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA626166OtherHARVARD PILGRIM HEALTHCAR
MA712451OtherCONNECTICARE
MAY67776OtherBLUE CROSS BLUE SHIELD
MA650020185OtherRAILROAD MEDICARE
MA2329180OtherAETNA US HEALTHCARE
MA0399329Medicaid
MA24189OtherHEALTH NEW ENGLAND
MA408459OtherTUFTS HEALTH PLAN
MA712451OtherCONNECTICARE
MATX1344Medicare PIN