Provider Demographics
NPI:1972697159
Name:MIZE, TED A I (PT)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:A
Last Name:MIZE
Suffix:I
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:PO BOX 9036
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313-9036
Mailing Address - Country:US
Mailing Address - Phone:928-717-7493
Mailing Address - Fax:
Practice Address - Street 1:500 US HIGHWAY 89 NORTH
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-717-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist