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General NPI Number Information
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NPI Number | 1235616095
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Entity Type | Individual
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Provider Name | MATTHEW JOSEPH MAZICK
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Gender | Male
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 527 TUSKEGEE AIRMAN AVE BUILDING 500
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City | SHEPPARD AFB
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State | TX
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Zip | 76311
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Country | US
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Telephone | 940-676-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 CHILDRESS ST
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City | SHEPPARD AFB
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State | TX
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Zip | 76311-4306
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Country | US
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Telephone | 478-954-2216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3761
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT016202
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License Number State | GA
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