Individual ProviderMichael James LattanzioPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address4079 Richmond Ave, Staten Island, NY 10312-5633(718) 984-8400(718) 447-6503PECOS EnrollmentBased on the most recent information from CMS, provider Michael James Lattanzio does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1063525921Provider TypeIndividualFull NameLattanzio, Michael JamesTitleMr.CredentialM.S., P.T.GenderMaleSole ProprietorNoEnumeration Date8/16/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address4079 Richmond Ave, Staten Island, NY 10312-5633Phone(718) 984-8400FaxUnlisted FaxMailing LocationMailing Address49 Pouch Terrace, Staten Island, NY 10305-2703Phone(718) 447-6503FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense027732New York