Provider Demographics
NPI:1770051476
Name:DIZINNO, CASEY NICOLE
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:NICOLE
Last Name:DIZINNO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 PINE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6960
Mailing Address - Country:US
Mailing Address - Phone:860-585-5800
Mailing Address - Fax:
Practice Address - Street 1:1090 MERIDEN WATERBURY TPKE
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-2055
Practice Address - Country:US
Practice Address - Phone:203-272-8490
Practice Address - Fax:203-272-8474
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14121225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
216213OtherOPTUM HEALTH PHYSICAL HEALTH