Provider Demographics
NPI:1912930058
Name:ZANZARELLA, SOFIA (PT)
Entity Type:Individual
Prefix:MS
First Name:SOFIA
Middle Name:
Last Name:ZANZARELLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ELM STREET
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-736-2250
Mailing Address - Fax:413-736-2254
Practice Address - Street 1:1111 ELM STREET
Practice Address - Street 2:SUITE 9
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-736-2250
Practice Address - Fax:413-736-2254
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0315991Medicaid
MA0315991Medicaid