Sandra Diane Fonzo, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

TE008826 Issued in PA

Practice address

395 Middle Rd
Nanticoke, PA 18634-3806

Phone

(570) 735-2973

NPI assigned

Mar 15, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1336840347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 RHODES TER",
            "city": "HARVEYS LAKE",
            "state": "PA",
            "postal_code": "186189777",
            "telephone_number": "570-200-5866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 MIDDLE RD",
            "city": "NANTICOKE",
            "state": "PA",
            "postal_code": "186343806",
            "telephone_number": "570-735-2973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONZO",
        "first_name": "SANDRA",
        "middle_name": "DIANE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-15",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TE008826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Nanticoke, PA
• Providers in Nanticoke, PA by specialty
• Physical Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.