Provider Demographics
NPI:1457744575
Name:MAZZONE, VINCENT (ATC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MAZZONE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WINCHELL AVE
Mailing Address - Street 2:APT 202
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2038
Mailing Address - Country:US
Mailing Address - Phone:630-854-6097
Mailing Address - Fax:
Practice Address - Street 1:3801 WINCHELL AVE
Practice Address - Street 2:APT 202
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2038
Practice Address - Country:US
Practice Address - Phone:630-854-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program