Provider Demographics
NPI:1639189921
Name:MACZA, JOANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:MACZA
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 1:909 PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3012
Mailing Address - Country:US
Mailing Address - Phone:314-802-7337
Mailing Address - Fax:844-744-5311
Practice Address - Street 1:909 PURDUE AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130
Practice Address - Country:US
Practice Address - Phone:314-802-7337
Practice Address - Fax:844-744-5311
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015034361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055008Medicare ID - Type Unspecified