Provider Demographics
NPI:1528617776
Name:ANZANO, RACHEL LYNN (DPT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:ANZANO
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 1:464 FAIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3410
Mailing Address - Country:US
Mailing Address - Phone:201-819-2775
Mailing Address - Fax:
Practice Address - Street 1:145 PIERMONT RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1022
Practice Address - Country:US
Practice Address - Phone:201-568-3355
Practice Address - Fax:201-568-3350
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01885000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist