Provider Demographics
NPI:1972645604
Name:CANNIZZARO, VIVIAN ELAINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ELAINE
Last Name:CANNIZZARO
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 1:17198 ST LUKES WAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8011
Mailing Address - Country:US
Mailing Address - Phone:936-273-2215
Mailing Address - Fax:936-273-2130
Practice Address - Street 1:3234 OLD CHAPEL DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-6050
Practice Address - Country:US
Practice Address - Phone:281-651-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2028884225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant