Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Evan Walsh Mazur

Individual provider Physical Therapist · NPI 1215452479

Evan Walsh Mazur is a Physical Therapist in Private Practice in Grand Rapids, Michigan. Qualified in 2015, 11 years ago. Practices with Advent Rehabilitation, LLC, a 57-clinician group and accepts Medicare assignment. Licensed in Colorado and Michigan.

Years since qualifying
11
Licensed in
CO, MI
In the registry since
2017
Specialties on file
2
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Practice location Address checks out

4085 Burton St SE Ste 100
Grand Rapids, MI 49546-2444
Phone: (616) 233-3599
Fax: (616) 385-6030
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 5501303510 (MI)
Physical Therapist Taxonomy 225100000X · Licence PTL.0013686 (CO)

Record details

NPI number1215452479
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 9, 2017
Last updated in NPPESFebruary 5, 2025
Certification dateFebruary 5, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Advent Rehabilitation, Llc — 57 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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