Provider Demographics
NPI:1801032263
Name:MAZALESKI, JAY A (PT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:MAZALESKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 GRACE CORPENING DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5864
Mailing Address - Country:US
Mailing Address - Phone:828-580-6821
Mailing Address - Fax:828-580-6822
Practice Address - Street 1:348 GRACE CORPENING DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5864
Practice Address - Country:US
Practice Address - Phone:828-580-6821
Practice Address - Fax:828-580-6822
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP6749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist