Provider Demographics
NPI:1487935193
Name:LIZZIO, THOMAS ROBERT (PT, DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:LIZZIO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3054
Mailing Address - Country:US
Mailing Address - Phone:856-222-9668
Mailing Address - Fax:
Practice Address - Street 1:220 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-4400
Practice Address - Country:US
Practice Address - Phone:856-910-7502
Practice Address - Fax:856-910-7505
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01406900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist