Healthcare Provider Details

I. General information

NPI: 1447461652
Provider Name (Legal Business Name): PATRIZIO M STANZIANO MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY NW SUITE 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

26 ELEANORDALE CIR.
ST. CATHARINES ONTARIO
L2M6X2
CA

V. Phone/Fax

Practice location:
  • Phone: 561-875-8999
  • Fax:
Mailing address:
  • Phone: 905-934-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028677
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002162
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-23233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: