1174844070 NPI number — MR. ANTHONY LAWRENCE SGHERZA PT, ATC

Table of content: MR. ANTHONY LAWRENCE SGHERZA PT, ATC (NPI 1174844070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174844070 NPI number — MR. ANTHONY LAWRENCE SGHERZA PT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SGHERZA
Provider First Name:
ANTHONY
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174844070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CABOT
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05647-9648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-563-3169
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 MIDDLE STREET
Provider Second Line Business Practice Location Address:
NORTHERN PHYSICAL THERAPY, PC
Provider Business Practice Location Address City Name:
LYNDONVILLE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-626-4224
Provider Business Practice Location Address Fax Number:
802-626-5042
Provider Enumeration Date:
06/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  040-0003584 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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