Basic Information
| Provider Information | |||||||||
| NPI: | 1669666582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZUR | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1385 S COLORADO BLVD # A-620 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802223304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036913733 | ||||||||
| FaxNumber: | 3036911142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1385 S COLORADO BLVD # A-620 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802223304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036913733 | ||||||||
| FaxNumber: | 3036808627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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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 | 070015953 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PTL.0012141 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PTL.0012141 | 01 | CO | PHYSICAL THERAPY LICENSE | OTHER |