Provider Demographics
NPI:1639911902
Name:PUZIO, DESIREE (MT)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:PUZIO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6442 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5102
Mailing Address - Country:US
Mailing Address - Phone:773-972-4445
Mailing Address - Fax:
Practice Address - Street 1:1881 NEW RIVER INLET RD
Practice Address - Street 2:
Practice Address - City:N TOPSAIL BEACH
Practice Address - State:NC
Practice Address - Zip Code:28460-9265
Practice Address - Country:US
Practice Address - Phone:773-972-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21849225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist