Provider Demographics
NPI:1871503169
Name:MAZUR, RACHEL MARIE (PT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:MAZUR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:ENDRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:52 MARANN TER
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14206-3438
Mailing Address - Country:US
Mailing Address - Phone:716-308-2327
Mailing Address - Fax:
Practice Address - Street 1:52 MARANN TER
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14206-3438
Practice Address - Country:US
Practice Address - Phone:716-308-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02695210Medicaid
NY02695210Medicaid