Provider Demographics
NPI:1295925196
Name:MAZZUCA, VICKI J (MSPT)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:J
Last Name:MAZZUCA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12705 KALAMATH CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-1771
Mailing Address - Country:US
Mailing Address - Phone:303-280-9793
Mailing Address - Fax:
Practice Address - Street 1:12705 KALAMATH CT
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1771
Practice Address - Country:US
Practice Address - Phone:303-280-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5586171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5586OtherPHYSICAL THERAPIST