Individual
MR. JONATHAN LIZOTTE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
721 RESERVOIR AVE, CRANSTON, RI 02910-4430
(401) 946-4250
(401) 275-5645
Mailing address
721 RESERVOIR AVE, CRANSTON, RI 02910-4430
(401) 946-4250
(401) 275-5645
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA00318
RI
225700000X
Massage Therapist
Primary
MT00964
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT00964
MASSAGE THERAPY LICENSE
RI
01
—
PTA00318
PHYSICAL THERAPY ASST. LC
RI
Enumeration date
05/20/2006
Last updated
09/11/2025
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