Provider Demographics
NPI:1750886313
Name:PEZZILLO, SANDRA (DPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PEZZILLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7246
Mailing Address - Country:US
Mailing Address - Phone:540-658-6500
Mailing Address - Fax:540-658-6042
Practice Address - Street 1:63 STAFFORD INDIANS LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-5803
Practice Address - Country:US
Practice Address - Phone:540-371-7200
Practice Address - Fax:540-371-2389
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist