Healthcare Provider Details

I. General information

NPI: 1730656133
Provider Name (Legal Business Name): ROSARIO ANZALONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7045 EVERGREEN WOODS TRL FL 34608
SPRING HILL FL
34608-1306
US

IV. Provider business mailing address

7384 ROYAL OAK DR
SPRING HILL FL
34607-2339
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-8371
  • Fax:
Mailing address:
  • Phone: 352-238-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number28802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: