Evan Walsh Mazur

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501303510 Issued in MI

Practice address

4085 Burton St SE Ste 100
Grand Rapids, MI 49546-2444

Phone

(616) 233-3599

Fax

(616) 385-6030

NPI assigned

Aug 9, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO, MI2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advent Rehabilitation, LLCGroup PAC ID 9537070545, 57 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advent Rehabilitation, LLC

  • Physical Therapist
  • Grand Rapids, MI
  • NPI 1780639658
  Medicare reassignment Care Compare group NPD
• Fox Rehabilitation Services Mi LLC

  • Physical Therapist
  • Canton, MI
  • NPI 1790324648
  Medicare reassignment NPD
• Colorado Spine Therapy, LLC

  • Orthopedic Physical Therapist
  • Denver, CO
  • NPI 1679766984
  Medicare reassignment NPD
• Panorama Orthopedics and Spine Center PC

  • Orthopaedic Surgery Physician
  • Golden, CO
  • NPI 1295787950
  Medicare reassignment NPD
• Advent Rehabilitation, LLC

  • Physical Therapist
  • Grand Rapids, MI
  • NPI 1437923729
  NPD
• Panorama Orthopedics & Spine Center, PC

  • Physical Therapy Clinic/Center
  • Colorado Springs, CO
  • NPI 1194390518
  NPD
• Panorama Orthopedics & Spine Center, PC

  • Physical Therapy Clinic/Center
  • Westminster, CO
  • NPI 1699397794
  NPD
• Panorama Orthopedics & Spine Center, PC

  • Physical Therapy Clinic/Center
  • Westminster, CO
  • NPI 1548971088
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1215452479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 PLAZA DR",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801292344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4085 BURTON ST SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462444",
            "telephone_number": "616-233-3599",
            "fax_number": "616-385-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUR",
        "first_name": "EVAN",
        "middle_name": "WALSH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-09",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0013686",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501303510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Alex Mazaris, MD
• Sandra Anne Mazaris
• Keaira Maze
• David Mazur, DO
• Dorothy E. Mazur, LMSW,DCSW
• Michael Mazur, DO
• Scott A Mazurek, DO
• Jennifer L Mazurkiewicz, MS OTR/L
• Aaron M Mazza, PT
• Karin K Mbae, MA

• Physical Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.