MEDICARE: MR. ANGELO J RIZZO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist	PT001083	GA
2	2251S0007X	Sports Physical Therapist	PT001083	GA
3	2251X0800X	Orthopedic Physical Therapist	PT001083	GA
4	225100000X	Physical Therapist	PT001083	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316163975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANGELO J RIZZO PT

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5005
Country	:	US
Telephone Number	:	572-084-7317
Fax Number	:	757-809-2370

Provider Business Practice Location Address
First Line	:	1157B WEST AVE SW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30012-5280
Country	:	US
Telephone Number	:	770-922-2420
Fax Number	:	770-922-1096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	10/20/2022

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