Active NPI
Jessica Lynn Mazuryk, DPT
- Physical Therapist
- Mankato, MN
National Provider Identifier
1710314109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10556
- Practice address
- 1025 Marsh St
Mankato, MN 56001-4752 - Phone
- (507) 625-4031
- NPI assigned
- Oct 1, 2013
- Last updated
- Mar 17, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8459588-2401 | UT | |
| Physical Therapist | 225100000X | 10556 | MN | Primary |
Addresses
Primary practice location
1025 Marsh St
Mankato, MN 56001-4752
Mailing address
1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 625-4031
Other practice location 1
528 W Pine St
Eagle River, WI 54521-9083
Phone (715) 477-1523
Other names 1
- Jessica Lynn Mack
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8459588-2401 | UT | MD | Physical Therapist |
| 10556 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1710314109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 MARSH ST",
"city": "MANKATO",
"state": "MN",
"postal_code": "560014752",
"telephone_number": "507-625-4031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 MARSH ST",
"city": "MANKATO",
"state": "MN",
"postal_code": "560014752",
"telephone_number": "507-625-4031"
}
],
"practiceLocations": [
{
"address_1": "528 W Pine St",
"address_purpose": "LOCATION",
"city": "Eagle River",
"state": "WI",
"postal_code": "545219083",
"country_code": "US",
"telephone_number": "715-477-1523",
"fax_number": "715-477-1524",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAZURYK",
"first_name": "JESSICA",
"middle_name": "LYNN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-01",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "8459588-2401",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "10556",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "MACK",
"middle_name": "LYNN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mankato, MN
- Mayo Clinic Health System-Southwest Minnesota Region (Mayo Clinic Health System - Mankato)
- Mayo Clinic Health System-Southwest Minnesota Region (Mayo Clinic Health System - Mankato)
- Mayo Clinic Health System-Southwest Minnesota Region (Mayo Clinic Health System-Mankato)
- Mayo Clinic Health System-Southwest Minnesota Region
- Mayo Foundation for Medical Education & Research (Mayo Clinic Store - Mankato)
- Divine Kapinga Mbuyi
- Jairus Matthew McBride, PHARM.D.
- Halle Mae McCabe
- John C McCabe, MD
- Jonathan Colin McCabe, MD, DMD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.