Provider Demographics
NPI:1235101205
Name:FAZZUOLI, DESPINA (PT)
Entity type:Individual
Prefix:MRS
First Name:DESPINA
Middle Name:
Last Name:FAZZUOLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2691
Mailing Address - Country:US
Mailing Address - Phone:774-449-8058
Mailing Address - Fax:777-449-8092
Practice Address - Street 1:133 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2691
Practice Address - Country:US
Practice Address - Phone:774-449-8058
Practice Address - Fax:774-449-8092
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469445OtherTUFTS
MA0319465Medicaid
MA57296OtherFALLON
MAY67697OtherBLUE SHIELD
MAY68440Medicare ID - Type Unspecified