Provider Demographics
NPI:1447461652
Name:STANZIANO, PATRIZIO M (MPT)
Entity type:Individual
Prefix:
First Name:PATRIZIO
Middle Name:M
Last Name:STANZIANO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ELEANORDALE CIR.
Mailing Address - Street 2:
Mailing Address - City:ST. CATHARINES
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L2M6X2
Mailing Address - Country:CA
Mailing Address - Phone:905-934-1122
Mailing Address - Fax:
Practice Address - Street 1:5901 BROKEN SOUND PKWY NW
Practice Address - Street 2:SUITE 500
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2773
Practice Address - Country:US
Practice Address - Phone:561-875-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028677225100000X
DEJ1-0002162225100000X
FLPT-23233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist