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Individual
MS. JUDITH MARIE MEZZOMO
Active
Individual
MS. JUDITH MARIE MEZZOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002663
CT
2255A2300X
Athletic Trainer
000010524
NULL
2255A2300X
Athletic Trainer
000273
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080002663CT02
BLUE CROSS BLUE SHIELD
CT
Enumeration date
08/02/2006
Last updated
04/05/2017
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