Provider Demographics
NPI:1477859148
Name:MOCZYDLOWSKI, DENISE (LMT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MOCZYDLOWSKI
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 1:2923 SE BAMBOO ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7805
Mailing Address - Country:US
Mailing Address - Phone:772-233-1832
Mailing Address - Fax:
Practice Address - Street 1:2923 SE BAMBOO ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7805
Practice Address - Country:US
Practice Address - Phone:772-233-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48003225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist