Provider Demographics
NPI:1194891002
Name:MAZER, JULIE M (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:MAZER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 LAKE RAYSTOWN SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-8403
Mailing Address - Country:US
Mailing Address - Phone:814-643-2476
Mailing Address - Fax:814-643-6775
Practice Address - Street 1:7643 LAKE RAYSTOWN SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-8403
Practice Address - Country:US
Practice Address - Phone:814-643-2476
Practice Address - Fax:814-643-6775
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013134L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP18125Medicare UPIN
PA043556KAOMedicare ID - Type UnspecifiedMEDICARE#