Provider Demographics
NPI:1568698793
Name:MAUZY, CAMERON A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:A
Last Name:MAUZY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13342 TIPPLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5554
Mailing Address - Country:US
Mailing Address - Phone:804-366-4485
Mailing Address - Fax:
Practice Address - Street 1:227 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4510
Practice Address - Country:US
Practice Address - Phone:804-323-7874
Practice Address - Fax:804-323-7879
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9819342OtherAETNA
VA1568698793Medicaid
VA225579OtherBCBS (PHYSICAL THERAPY)
VAP00726346OtherRAILROAD MEDICARE
VA1568698793Medicaid
VAC05954Medicare PIN