Provider Demographics
NPI:1114419298
Name:MAZZOTTI, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MAZZOTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HEARD ST UNIT 511
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-1972
Mailing Address - Country:US
Mailing Address - Phone:330-472-4954
Mailing Address - Fax:
Practice Address - Street 1:135 N BEACON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2751
Practice Address - Country:US
Practice Address - Phone:617-923-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist