Provider Demographics
NPI:1932456290
Name:MEZYK, NICHOLAS R (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:MEZYK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 ZION RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-9141
Mailing Address - Country:US
Mailing Address - Phone:814-355-5660
Mailing Address - Fax:814-355-5644
Practice Address - Street 1:1680 ZION RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9141
Practice Address - Country:US
Practice Address - Phone:814-355-5660
Practice Address - Fax:814-355-5644
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist