Provider Demographics
NPI:1255711883
Name:CAZZANI, ROSE MARIE
Entity type:Individual
Prefix:
First Name:ROSE MARIE
Middle Name:
Last Name:CAZZANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E BEL AIR RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4525
Mailing Address - Country:US
Mailing Address - Phone:401-338-0125
Mailing Address - Fax:401-435-4231
Practice Address - Street 1:45 E BEL AIR RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4525
Practice Address - Country:US
Practice Address - Phone:401-392-0564
Practice Address - Fax:401-435-4231
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA00404208100000X
RIPT00404225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255711883OtherNPI