Provider Demographics
NPI:1649262387
Name:POLIZZOTTO, ROBERTA JEAN (ATC)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:JEAN
Last Name:POLIZZOTTO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2373 SWEETBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-6402
Mailing Address - Country:US
Mailing Address - Phone:803-324-3615
Mailing Address - Fax:
Practice Address - Street 1:WINTHROP UNIVERSITY
Practice Address - Street 2:31 WINTHROP UNIVERSITY COLISEUM
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29733-0001
Practice Address - Country:US
Practice Address - Phone:803-323-2509
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6412255A2300X
PART000512A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer