Provider Demographics
NPI:1720330723
Name:MAZZEO, MICHAEL (DR OF PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAZZEO
Suffix:
Gender:F
Credentials:DR OF PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-567-0566
Mailing Address - Fax:
Practice Address - Street 1:160 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1419
Practice Address - Country:US
Practice Address - Phone:609-567-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01460800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist