Provider Demographics
NPI:1235248881
Name:MAZUREK, AMY ELIZABETH (MPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:MAZUREK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30656 INDIGO ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1485
Mailing Address - Country:US
Mailing Address - Phone:586-774-5234
Mailing Address - Fax:
Practice Address - Street 1:22255 GREENFIELD RD STE 130
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3700
Practice Address - Country:US
Practice Address - Phone:248-304-7776
Practice Address - Fax:248-918-2024
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501011614OtherLICENSE