Provider Demographics
NPI:1053756882
Name:JANNUZZI, JOSEPH (DPT, SCS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:JANNUZZI
Suffix:
Gender:M
Credentials:DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 S RIVA RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2507
Mailing Address - Country:US
Mailing Address - Phone:208-949-0568
Mailing Address - Fax:
Practice Address - Street 1:2294 S RIVA RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2507
Practice Address - Country:US
Practice Address - Phone:208-949-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-31522251S0007X, 2251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic