MEDICARE: JUSTIN MAURIZIO 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
1	225100000X	Physical Therapist	10593	CT

General Provider Information

NPI Number	:	1508242710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN MAURIZIO DPT

Provider Business Mailing Address
First Line	:	1 BRADLEY RD STE 801
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2296
Country	:	US
Telephone Number	:	203-389-4593
Fax Number	:	203-389-4609

Provider Business Practice Location Address
First Line	:	103 N MAIN ST
Second Line	:
City	:	BRANFORD
State	:	CT
Zip	:	06405-3034
Country	:	US
Telephone Number	:	203-433-4683
Fax Number	:

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

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	08/11/2015

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Directions to “ JUSTIN MAURIZIO DPT” Practice Location

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