Provider Demographics
NPI:1013481068
Name:MROZ, PAIGE (DPT, ATC)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:MROZ
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 BRYANT FARMS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1642
Mailing Address - Country:US
Mailing Address - Phone:980-207-2707
Mailing Address - Fax:980-207-2783
Practice Address - Street 1:9405 BRYANT FARMS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1642
Practice Address - Country:US
Practice Address - Phone:980-207-2707
Practice Address - Fax:980-207-2783
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NCP23524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer