Individual
WYATT ANTHONY MAZOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS
Contact information
Practice address
2725 S 144TH ST STE 218, OMAHA, NE 68144-5253
(402) 741-2176
Mailing address
2725 S 144TH ST STE 218, OMAHA, NE 68144-5253
(402) 741-2176
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4522
NE
Other
Enumeration date
08/23/2023
Last updated
08/23/2023
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