MEDICARE: MS. TINA LOUISE AZZANO

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	225100000X	Physical Therapist	PT013836L	PA
2	225100000X	Physical Therapist	021715-1	NY
3	225100000X	Physical Therapist	33722	CA

General Provider Information

NPI Number	:	1174756530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TINA LOUISE AZZANO

Provider Business Mailing Address
First Line	:	64 DANBURY RD
Second Line	:
City	:	WILTON
State	:	CT
Zip	:	06897-4429
Country	:	US
Telephone Number	:	800-278-0332
Fax Number	:	800-570-5001

Provider Business Practice Location Address
First Line	:	7310 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3412
Country	:	US
Telephone Number	:	800-278-0332
Fax Number	:	800-570-5001

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

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/01/2009

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