Provider Demographics
NPI:1699737999
Name:MAZZATELLI, ALISON (DPT)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:MAZZATELLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WHITE EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5043
Mailing Address - Country:US
Mailing Address - Phone:609-276-3240
Mailing Address - Fax:
Practice Address - Street 1:50 PLAZA DR STE 104
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8549
Practice Address - Country:US
Practice Address - Phone:386-447-5447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01148700225100000X
FL35983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist