Provider Demographics
NPI:1952880403
Name:GOZUN, MERCEDES BIHIS
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:BIHIS
Last Name:GOZUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8734 SPRING FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6441
Mailing Address - Country:US
Mailing Address - Phone:260-450-0481
Mailing Address - Fax:
Practice Address - Street 1:8734 SPRING FOREST DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6441
Practice Address - Country:US
Practice Address - Phone:260-450-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002648A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist