Individual
JOSE MARCELO E SOUZA MAFRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
102 S BONAVENTURE AVE, TRINIDAD, CO 81082-2054
(719) 846-8072
(710) 846-8071
Mailing address
7620 GRIZZLY ROSE WAY, COLORADO SPRINGS, CO 80923-5501
(719) 846-8072
(719) 846-8071
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PTL.0016237
CO
Other
Enumeration date
03/18/2026
Last updated
03/18/2026
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