Provider Demographics
NPI:1093565285
Name:MAZURKIEWICZ, ROXANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:MAZURKIEWICZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 N LOOP 288 APT 8308
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-7131
Mailing Address - Country:US
Mailing Address - Phone:469-744-4024
Mailing Address - Fax:
Practice Address - Street 1:3909 N LOOP 288 APT 8308
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-7131
Practice Address - Country:US
Practice Address - Phone:469-744-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35982225100000X
TX1247968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist