Provider Demographics
NPI:1952446106
Name:VIZZERRA, CARLA LOZANO (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:LOZANO
Last Name:VIZZERRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:MABELLE
Other - Last Name:LOZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:642 S ALASKA ST
Mailing Address - Street 2:#209
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6342
Mailing Address - Country:US
Mailing Address - Phone:907-746-0722
Mailing Address - Fax:907-746-0732
Practice Address - Street 1:642 S ALASKA ST
Practice Address - Street 2:#209
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6342
Practice Address - Country:US
Practice Address - Phone:907-746-0722
Practice Address - Fax:907-746-0732
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT7391Medicaid
AK153373Medicare PIN