Provider Demographics
NPI:1669666582
Name:MAZUR, ALAN M (PT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:MAZUR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 S COLORADO BLVD # A-620
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3304
Mailing Address - Country:US
Mailing Address - Phone:303-691-3733
Mailing Address - Fax:303-691-1142
Practice Address - Street 1:1385 S COLORADO BLVD # A-620
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3304
Practice Address - Country:US
Practice Address - Phone:303-691-3733
Practice Address - Fax:303-680-8627
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015953225100000X
COPTL.0012141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL.0012141OtherPHYSICAL THERAPY LICENSE