Provider Demographics
NPI:1396747341
Name:MAZZOLI, LINDA FABRIZIO (MS, ATC, PTA, PES)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FABRIZIO
Last Name:MAZZOLI
Suffix:
Gender:F
Credentials:MS, ATC, PTA, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4415
Mailing Address - Country:US
Mailing Address - Phone:610-494-6608
Mailing Address - Fax:610-364-1815
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 411
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-912-0416
Practice Address - Fax:610-364-1815
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001655L225200000X
NJ25MT001029002255A2300X
PART001182A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer