Provider Demographics
NPI:1811970320
Name:MAZUR, MARC JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:JOSEPH
Last Name:MAZUR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2111 SAWYER DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2975
Mailing Address - Country:US
Mailing Address - Phone:716-731-2195
Mailing Address - Fax:716-731-4862
Practice Address - Street 1:2111 SAWYER DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2975
Practice Address - Country:US
Practice Address - Phone:716-731-2195
Practice Address - Fax:716-731-4862
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist