Active NPI
Matthew Scott Mazara, PTA
- Physical Therapy Assistant
- D'Iberville, MS
National Provider Identifier
1053787689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5837
- Practice address
- 10470 Diberville Blvd
Diberville, MS 39540-2419 - Phone
- (228) 280-8120
- Fax
- (228) 280-8121
- NPI assigned
- Aug 18, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5837 | MS | Primary |
Addresses
Primary practice location
10470 Diberville Blvd
Diberville, MS 39540-2419
Mailing address
10470 Diberville Blvd
Diberville, MS 39540-2419
Phone (228) 280-8120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5837 | MS | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439856000000",
"number": "1053787689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10470 DIBERVILLE BLVD",
"city": "DIBERVILLE",
"state": "MS",
"postal_code": "395402419",
"telephone_number": "228-280-8120",
"fax_number": "228-280-8121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10470 DIBERVILLE BLVD",
"city": "DIBERVILLE",
"state": "MS",
"postal_code": "395402419",
"telephone_number": "228-280-8120",
"fax_number": "228-280-8121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZARA",
"first_name": "MATTHEW",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-18",
"last_updated": "2015-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MS",
"license": "5837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in D'Iberville, MS
- Catherine Ann Louiselle
- Magnolia Bloom Counseling, LLC
- Alyssa Fuller Martin, DPT
- Katelyn Elizabeth Martin, BCBA, LBA
- Maxem Health Urgent Care Diberville
- Rachael Elizabeth McAllister, RN
- Yostin Zambrano McKelroy, MSN, APRN, FNP-C
- Colleen J. McNulty
- Cynthia J McPherson-Richardson, LPC
- Mississippi Center for Autism and Related Developmental Disabilities
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.