Provider Demographics
NPI:1174586572
Name:MAZZEI, LAUREN L (MPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:L
Last Name:MAZZEI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:E
Other - Middle Name:LAUREN
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:520 PELLIS RD
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4777
Mailing Address - Country:US
Mailing Address - Phone:724-850-7587
Mailing Address - Fax:724-850-9909
Practice Address - Street 1:1 DOLLY AVE
Practice Address - Street 2:UNIT B-2
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-1042
Practice Address - Country:US
Practice Address - Phone:724-527-3999
Practice Address - Fax:724-527-3320
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013797L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018946040002Medicaid
PAP60721Medicare UPIN
PA058478Medicare ID - Type Unspecified