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

Mark Defazio, PTA

Individual provider Physical Therapy Assistant · NPI 1619503125

Mark Defazio, PTA is a Physical Therapy Assistant in Boston, Massachusetts. Licensed in Massachusetts. Registered with an NPI since 2020.

Licensed in
MA
In the registry since
2020
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

185 Harrison Ave
Boston, MA 02111-1804
Phone: (617) 636-5632
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 9532 (MA)

Record details

NPI number1619503125
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedMarch 16, 2020
Last updated in NPPESMarch 16, 2020
Certification dateMarch 16, 2020
Mailing address39 Chipman St, Medford, MA 02155-4058

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