Provider Demographics
NPI:1417229733
Name:MRAZ, MICHAEL J (MPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:MRAZ
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5322 RAVENS CREST DR E
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-2473
Mailing Address - Country:US
Mailing Address - Phone:848-702-4545
Mailing Address - Fax:
Practice Address - Street 1:219 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2517
Practice Address - Country:US
Practice Address - Phone:201-907-3150
Practice Address - Fax:201-907-3155
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ40QA01078400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist