MEDICARE: MAKENZIE MAZIN DSCPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305203359	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F8710015	OTHER	DC	CAREFIRST BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1407835291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENZIE MAZIN DSCPT

Provider Business Mailing Address
First Line	:	5131 BALLYCASTLE CIR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-5566
Country	:	US
Telephone Number	:	703-786-3352
Fax Number	:

Provider Business Practice Location Address
First Line	:	5131 BALLYCASTLE CIR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-5566
Country	:	US
Telephone Number	:	703-786-3352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	04/12/2023

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Directions to “ MAKENZIE MAZIN DSCPT” Practice Location

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