Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT001083 | GA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT001083 | GA |
N | 2251S0007X | Physical Therapist - Sports | PT001083 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT001083 | GA |
NPI | 1316163975 |
---|---|
Provider Name | Angelo J Rizzo |
First Address | Conyers, GA 30012-3838 |
Second Address | Conyers, GA 30012-3838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 01/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
460381266A | (05) | GA |