Individual
DOUGLAS MAZUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS PT
Contact information
Practice address
224 BUTTERNUT ST, WEST BEND, WI 53095-4910
(262) 365-0650
(262) 365-0651
Mailing address
11501 N PARKVIEW DR, MEQUON, WI 53092-1920
(262) 365-0650
(262) 365-0651
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4798
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4798
LICENSE NUMBER
WI
Enumeration date
08/30/2006
Last updated
07/08/2007
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