Provider Demographics
NPI:1144307109
Name:CARROZZO, ANTHONY D
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:CARROZZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1105
Mailing Address - Country:US
Mailing Address - Phone:215-285-4105
Mailing Address - Fax:
Practice Address - Street 1:1 E BEACON LIGHT LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4409
Practice Address - Country:US
Practice Address - Phone:610-619-0303
Practice Address - Fax:610-619-0305
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003622L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06963Medicare UPIN