Provider Demographics
NPI:1306855085
Name:MAZUR, SARADNA (LMT)
Entity Type:Individual
Prefix:
First Name:SARADNA
Middle Name:
Last Name:MAZUR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 NW 106TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8083
Mailing Address - Country:US
Mailing Address - Phone:352-331-9612
Mailing Address - Fax:352-331-9612
Practice Address - Street 1:1033 NW 106TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8083
Practice Address - Country:US
Practice Address - Phone:352-331-9612
Practice Address - Fax:352-331-9612
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist