Provider Demographics
NPI:1982673125
Name:MAZYK, PETER (MPT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MAZYK
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 1:5237 PLEASANT MILLS RD
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-4109
Mailing Address - Country:US
Mailing Address - Phone:609-804-8861
Mailing Address - Fax:
Practice Address - Street 1:321 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2600
Practice Address - Country:US
Practice Address - Phone:609-927-4011
Practice Address - Fax:609-927-4019
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01054900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist