Provider Demographics
NPI:1447621487
Name:ITALIA, ANN (PTA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:ITALIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0323
Mailing Address - Country:US
Mailing Address - Phone:603-817-2338
Mailing Address - Fax:
Practice Address - Street 1:82 AMESBURY RD
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:NH
Practice Address - Zip Code:03833-5619
Practice Address - Country:US
Practice Address - Phone:603-817-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0566225200000X
MA9018225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant