Provider Demographics
NPI:1164544961
Name:MOZER, LORA SUE (PT)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:SUE
Last Name:MOZER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 E BELLEVIEW AVE
Mailing Address - Street 2:SUITE 428-C
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2803
Mailing Address - Country:US
Mailing Address - Phone:303-741-5522
Mailing Address - Fax:303-741-8698
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 428-C
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-741-5522
Practice Address - Fax:303-741-8698
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804164Medicare UPIN