Provider Demographics
NPI:1003363318
Name:MAZUR, NAOMI
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:MAZUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:WOODCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4380
Mailing Address - Country:US
Mailing Address - Phone:860-549-8975
Mailing Address - Fax:
Practice Address - Street 1:345 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4380
Practice Address - Country:US
Practice Address - Phone:860-549-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60690875225100000X
CT011834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist