Provider Demographics
NPI:1699816314
Name:RIZZO, THOMAS (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:RIZZO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4023
Mailing Address - Country:US
Mailing Address - Phone:608-890-6110
Mailing Address - Fax:608-221-6250
Practice Address - Street 1:1050 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4023
Practice Address - Country:US
Practice Address - Phone:608-890-6110
Practice Address - Fax:608-221-6250
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11627-24225100000X, 2251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports