Mark Defazio, PTA
Physical Therapy Assistant in Boston, Massachusetts
1619503125- Practice location
- 185 Harrison Ave, Boston, MA 02111-1804
- Phone
- 617-636-5632
- Fax
- —
- Last updated
- March 16, 2020
Mark Defazio is a Physical Therapy Assistant based in Boston, MA. Mark Defazio practices in Boston, MA and has the professional credentials of PTA. The NPI Number for Mark Defazio is 1619503125 and holds a License No. 9532 (MA). The current practice location address for Mark Defazio is 185 Harrison Ave, Boston, MA 02111-1804 and can be reached out via phone at 617-636-5632.
Provider Profile Details
- NPI Number
- 1619503125
- Provider Name
- Mark Defazio
- Credential
- PTA
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 185 Harrison Ave, Boston, MA 02111-1804
- Phone Number
- 617-636-5632
- Primary Taxonomy
- Physical Therapy Assistant · 225200000X
- Sole Proprietor
- No
- Provider Enumeration Date
- March 16, 2020
- Last Update Date
- March 16, 2020
- Certification Date
- March 16, 2020
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 185 Harrison Ave
Boston, MA 02111-1804 - City
- Boston
- State
- Massachusetts
- Zip
- 02111-1804
- Phone Number
- 617-636-5632
Provider Business Mailing Address Details
- Address
- 39 Chipman St
Medford, MA 02155-4058 - City
- Medford
- State
- MA
- Zip
- 02155-4058
- Phone Number
- 781-535-8636
License Information
- License Number
- 9532
- License State
- MA
- Taxonomy
- Physical Therapy Assistant · 225200000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Mark Defazio, PTA?
The NPI number of Mark Defazio, PTA is 1619503125. It was assigned on March 16, 2020 and is currently active in the NPPES registry.
What is the specialty of Mark Defazio, PTA?
Mark Defazio, PTA is registered under the primary taxonomy Physical Therapy Assistant (code 225200000X), licensed in MA under license number 9532.
Where does Mark Defazio, PTA practice?
The practice location is 185 Harrison Ave, Boston, MA 02111-1804. The office can be reached at 617-636-5632 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1619503125 directly on the NPPES registry website.