Basic Information
| Provider Information | |||||||||
| NPI: | 1124347190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZOR | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ALAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 BAHIA VISTA ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342392640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419512663 | ||||||||
| FaxNumber: | 9419574437 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 BAHIA VISTA ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342392600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419512663 | ||||||||
| FaxNumber: | 9419574437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 01/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 24233 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.