Provider Demographics
NPI:1134273626
Name:MAZUCA, ARTHUR G (PT)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:G
Last Name:MAZUCA
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 1:15734 SWEETWATER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1612
Mailing Address - Country:US
Mailing Address - Phone:713-823-9498
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2735
Practice Address - Country:US
Practice Address - Phone:713-357-7400
Practice Address - Fax:713-357-7401
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151779225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D3350Medicare ID - Type Unspecified