Douglas Mazur, MS PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4798 Issued in WI

Practice address

224 Butternut St
West Bend, WI 53095-4910

Phone

(262) 365-0650

Fax

(262) 365-0651

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Life Adventure Therapies, LLC

  • Mental Health Counselor
  • Mequon, WI
  • NPI 1245254788
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710097241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11501 N PARKVIEW DR",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530921920",
            "telephone_number": "262-365-0650",
            "fax_number": "262-365-0651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 BUTTERNUT ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530954910",
            "telephone_number": "262-365-0650",
            "fax_number": "262-365-0651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUR",
        "first_name": "DOUGLAS",
        "credential": "MS PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "4798",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Jeanne Martenet, LPC IT
• Tonya Kathleen Maser, RN
• Betty L Mayer, PT
• Mayville Family Practice LLC
• Kerrie Marie Mazeika, MSW, LCSW
• MB Counseling Center of West Bend, LLC
• Emily McCabe
• Andrea L McCarthy, P.T.
• Rachel McCauley, NP
• McCormack Chiropractic SC

• Physical Therapist in West Bend, WI
• Providers in West Bend, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.