Provider Demographics
NPI:1871277293
Name:MAZESKI, ZACHARY JAMES (DPT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAMES
Last Name:MAZESKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3072
Mailing Address - Country:US
Mailing Address - Phone:541-980-4774
Mailing Address - Fax:
Practice Address - Street 1:13128 N 94TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4254
Practice Address - Country:US
Practice Address - Phone:623-974-1797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist