Provider Demographics
NPI:1205902228
Name:CATALLOZZI, MILVA (MS,PT)
Entity type:Individual
Prefix:MS
First Name:MILVA
Middle Name:
Last Name:CATALLOZZI
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114099
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-0299
Mailing Address - Country:US
Mailing Address - Phone:401-353-9100
Mailing Address - Fax:401-353-9101
Practice Address - Street 1:1417 DOUGLAS AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4057
Practice Address - Country:US
Practice Address - Phone:401-353-9100
Practice Address - Fax:401-353-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007058277Medicare ID - Type UnspecifiedPROVIDER# 659004650