Provider Demographics
NPI:1174756530
Name:AZZANO, TINA LOUISE
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:LOUISE
Last Name:AZZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:AZZANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:64 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4429
Mailing Address - Country:US
Mailing Address - Phone:800-278-0332
Mailing Address - Fax:800-570-5001
Practice Address - Street 1:7310 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-3412
Practice Address - Country:US
Practice Address - Phone:800-278-0332
Practice Address - Fax:800-570-5001
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013836L225100000X
NY021715-1225100000X
CA33722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist