Provider Demographics
NPI:1164733846
Name:MAZZA, AMY MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:MAZZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 APPLE ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-2868
Mailing Address - Country:US
Mailing Address - Phone:513-574-2770
Mailing Address - Fax:
Practice Address - Street 1:440 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-1022
Practice Address - Country:US
Practice Address - Phone:513-221-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT004947314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility