Provider Demographics
NPI:1407835291
Name:MAZIN, MAKENZIE (DSCPT)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:MAZIN
Suffix:
Gender:F
Credentials:DSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 BALLYCASTLE CIR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5566
Mailing Address - Country:US
Mailing Address - Phone:703-786-3352
Mailing Address - Fax:
Practice Address - Street 1:5131 BALLYCASTLE CIR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5566
Practice Address - Country:US
Practice Address - Phone:703-786-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203359225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF8710015OtherCAREFIRST BLUE CROSS BLUE SHIELD
DCF8710015OtherCAREFIRST BLUE CROSS BLUE SHIELD