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1619503125
MARK DEFAZIO
BOSTON, MA
NPI
1619503125
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: MA 9532)
Enumeration Date
2020-03-16
Last Update Date
2020-03-16
Business Address
MARK DEFAZIO PTA
185 HARRISON AVE
BOSTON, MA 02111-1804
Phone number: 617-636-5632
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Mailing Address
MARK DEFAZIO PTA
39 CHIPMAN ST
MEDFORD, MA 02155-4058
Phone number: 781-535-8636
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