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General NPI Number Information
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NPI Number | 1922004761
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Entity Type | Individual
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Provider Name | SHELLEY A. MAZZIE MPT
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Gender | Female
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 9848 NORTH TRYON STREET
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City | CHARLOTTE
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State | NC
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Zip | 28262
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Country | US
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Telephone | 704-323-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 PARK RD SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28209-3239
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Country | US
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Telephone | 704-323-2000
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 001799
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License Number State | WV
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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 | 12370
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License Number State | NC
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