MEDICARE: MRS. ELIZABETH E. MAZUK PTA

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	225200000X	Physical Therapy Assistant	40QB00007300	NJ

General Provider Information

NPI Number	:	1548216591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH E. MAZUK PTA

Provider Business Mailing Address
First Line	:	PO BOX 83
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-0083
Country	:	US
Telephone Number	:	609-704-1980
Fax Number	:	609-704-9054

Provider Business Practice Location Address
First Line	:	640 S WHITE HORSE PIKE
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-2014
Country	:	US
Telephone Number	:	609-704-1980
Fax Number	:	609-704-1980

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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