Provider Demographics
NPI:1265060602
Name:BOZZO, SABRINA (PTA)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:BOZZO
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 1:3118 41ST ST
Mailing Address - Street 2:APT 1F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3903
Mailing Address - Country:US
Mailing Address - Phone:313-282-9876
Mailing Address - Fax:
Practice Address - Street 1:3118 41ST ST
Practice Address - Street 2:APT 1F
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3903
Practice Address - Country:US
Practice Address - Phone:313-282-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012315225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant