Individual
MS. RITA L DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
380H KNOLLWOOD ST # 133, WINSTON SALEM, NC 27103-1815
(336) 692-6820
Mailing address
380H KNOLLWOOD ST #133, WINSTONSALEM, NC 27103
(336) 692-6820
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
11341
NC
174400000X
Specialist
Primary
PT35845
CA
174400000X
Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174743058
—
CA
05
—
1174743058
—
NC
05
—
1174743058
—
TX
Enumeration date
04/26/2007
Last updated
03/11/2011
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