Provider Demographics
NPI:1992835011
Name:MAZZOLA, ANNA ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:ELIZABETH
Last Name:MAZZOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ELIZABETH
Other - Last Name:GERENCSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1786 RAMHURST DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9579
Mailing Address - Country:US
Mailing Address - Phone:336-766-7044
Mailing Address - Fax:
Practice Address - Street 1:3350 SILAS CREEK PARKWAY
Practice Address - Street 2:SILAS CREEK MANOR
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104
Practice Address - Country:US
Practice Address - Phone:914-441-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012363-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11282OtherNC PT BOARD