Provider Demographics
NPI:1154050458
Name:MAZANKOWSKI, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MAZANKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W SOUTH 1ST ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9232
Mailing Address - Country:US
Mailing Address - Phone:970-660-5000
Mailing Address - Fax:
Practice Address - Street 1:111 W SOUTH 1ST ST UNIT A
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9232
Practice Address - Country:US
Practice Address - Phone:970-660-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist