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NPI Code Detail

MEDICARE: DR. JUSTIN MICHAEL MAUZY DPT

MEDICARE: DR. JUSTIN MICHAEL MAUZY DPT
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
1208100000XPhysical Medicine & Rehabilitation PhysicianP20965NC
2208100000XPhysical Medicine & Rehabilitation Physician2305213280VA
3208100000XPhysical Medicine & Rehabilitation PhysicianCP028099TDC
4208100000XPhysical Medicine & Rehabilitation PhysicianCP025408TMD
5225100000XPhysical TherapistPTL80993MA

General Provider Information

NPI Number : 1164061388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN MICHAEL MAUZY DPT
Provider Business Mailing Address
First Line : 4 RICHMOND SQ
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-5117
Country : US
Telephone Number : 401-433-4172
Fax Number : 401-433-0612
Provider Business Practice Location Address
First Line : 31 ANDREW AVE
Second Line :
City : WAYLAND
State : MA
Zip : 01778-3026
Country : US
Telephone Number : 508-358-3410
Fax Number : 844-912-8609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2020
Last Update Date : 10/16/2025

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