Provider Demographics
NPI:1538758008
Name:ZACCHIA, AMANDA (RPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ZACCHIA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3888
Mailing Address - Country:US
Mailing Address - Phone:860-919-2986
Mailing Address - Fax:
Practice Address - Street 1:2021 ALBANY AVE # A
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2789
Practice Address - Country:US
Practice Address - Phone:860-570-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist