Individual
SANDRA DIANE FONZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
395 MIDDLE RD, NANTICOKE, PA 18634-3806
(570) 735-2973
Mailing address
28 RHODES TER, HARVEYS LAKE, PA 18618-9777
(570) 200-5866
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE008826
PA
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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