Provider Demographics
NPI:1497536635
Name:MOCZYGEMBA, SHELBY MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:MOCZYGEMBA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:MARIE
Other - Last Name:MALEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:14207 HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1252
Mailing Address - Country:US
Mailing Address - Phone:210-826-4492
Mailing Address - Fax:
Practice Address - Street 1:14207 HIGGINS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1252
Practice Address - Country:US
Practice Address - Phone:210-826-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1282102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist