MEDICARE: DR. JOHN JOSEPH ANZALONE DPT

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	005037	IA
2	225100000X	Physical Therapist	2678	NE
3	225100000X	Physical Therapist	3693	NM

General Provider Information

NPI Number	:	1437407061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JOSEPH ANZALONE DPT

Provider Business Mailing Address
First Line	:	2802 CASTLES GATE DR.
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-0707
Country	:	US
Telephone Number	:	712-266-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 CASTLES GATE DR.
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-0707
Country	:	US
Telephone Number	:	712-266-0707
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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