Provider Demographics
NPI:1316163975
Name:RIZZO, ANGELO J (PT)
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:J
Last Name:RIZZO
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:572-084-7317
Mailing Address - Fax:757-809-2370
Practice Address - Street 1:1157B WEST AVE SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5280
Practice Address - Country:US
Practice Address - Phone:770-922-2420
Practice Address - Fax:770-922-1096
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPT0010832251G0304X, 2251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA460381266AMedicaid
GA116718Medicare ID - Type Unspecified