Provider Demographics
NPI:1265431068
Name:MAASZ, KATHRYN
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MAASZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 STATE ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4934 PEACH ST
Practice Address - Street 2:ATTN: TRAC REHAB PEACH
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2043
Practice Address - Country:US
Practice Address - Phone:814-864-5097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT004105L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016786370012Medicaid
PA3110691OtherAETNA
PAP00063597OtherRR MEDICARE
PA653766OtherBLUE SHIELD
NY00025450302OtherUNIVERA
PA653766OtherBLUE SHIELD
PA067963E7CMedicare PIN