Provider Demographics
NPI:1013929850
Name:MAZANEK, DEBORAH ANNE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:MAZANEK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PEACHTREE LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4439
Mailing Address - Country:US
Mailing Address - Phone:757-865-8454
Mailing Address - Fax:
Practice Address - Street 1:732 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 906
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4218
Practice Address - Country:US
Practice Address - Phone:757-248-9191
Practice Address - Fax:757-596-2666
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist