Provider Demographics
NPI:1881700854
Name:RANDAZZO, JEANINE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:MARIE
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JEANINE
Other - Middle Name:MARIE
Other - Last Name:AMATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 MOE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3821
Mailing Address - Country:US
Mailing Address - Phone:518-280-4294
Mailing Address - Fax:518-280-4297
Practice Address - Street 1:515 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3821
Practice Address - Country:US
Practice Address - Phone:518-280-4294
Practice Address - Fax:518-280-4297
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007950225100000X
NY030491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist