Provider Demographics
NPI:1316076730
Name:PIZZAGALLI, JENNIFER VARRICCHIONE (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VARRICCHIONE
Last Name:PIZZAGALLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 PINE HAVEN SHORES LN
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7707
Mailing Address - Country:US
Mailing Address - Phone:802-985-5787
Mailing Address - Fax:
Practice Address - Street 1:208 FLYNN AVE # STUDIO3A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5429
Practice Address - Country:US
Practice Address - Phone:802-860-0356
Practice Address - Fax:802-860-2356
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist