Mark Defazio, PTA

Physical Therapy Assistant · Boston, MA

Individual Active NPI

NPI number 1619503125

Practice location

185 Harrison Ave
Boston, MA 02111-1804
Phone
(617) 636-5632

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NPI record

NPI
1619503125
Entity type
Individual (Type 1)
Enumeration date
March 16, 2020
Last updated
March 16, 2020
Certified
March 16, 2020
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physical Therapy Assistant Primary 225200000X 9532 MA

Mailing address

39 Chipman St
Medford, MA 02155-4058
Phone
(781) 535-8636

About Mark Defazio

Mark Defazio, PTA is a healthcare provider registered in the NPI registry with the primary taxonomy Physical Therapy Assistant (code 225200000X). The practice location is 185 Harrison Ave, Boston, MA 02111-1804. The NPI number 1619503125 was assigned on March 16, 2020 and the record was last updated on March 16, 2020.

Mark Defazio lists a license in the registry: #9532 (MA) for Physical Therapy Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Mark Defazio, PTA?

The NPI number is 1619503125.

What is the phone number of Mark Defazio?

The phone number listed for the practice location is (617) 636-5632.

Where is Mark Defazio located?

185 Harrison Ave, Boston, MA 02111-1804.

What is the taxonomy code for Mark Defazio?

The primary taxonomy code is 225200000X – Physical Therapy Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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