Provider Demographics
NPI:1992124242
Name:MAZZIE, MATTHEW (AT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MAZZIE
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 LIEB RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8109
Mailing Address - Country:US
Mailing Address - Phone:484-264-3068
Mailing Address - Fax:
Practice Address - Street 1:1280 LIEB RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8109
Practice Address - Country:US
Practice Address - Phone:484-264-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer