Provider Demographics
NPI:1518475722
Name:MOZART, MICHELLE LUCILLE (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LUCILLE
Last Name:MOZART
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 1:10503 W THUNDERBIRD BLVD STE 263A
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3048
Mailing Address - Country:US
Mailing Address - Phone:623-832-5349
Mailing Address - Fax:623-832-6661
Practice Address - Street 1:10503 W THUNDERBIRD BLVD STE 263A
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3048
Practice Address - Country:US
Practice Address - Phone:623-832-5349
Practice Address - Fax:623-832-6661
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist