# VICKI J MAZZUCA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1295925196
- **Gender:** F
- **Credential:** MSPT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171W00000X | Contractor | 5586 | CO | Yes |

## Other

- **Enumeration date:** 07/26/2007
- **Last updated:** 07/26/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5586 | PHYSICAL THERAPIST | CO |