Provider Demographics
NPI:1104827047
Name:MAZUREK, RENEE M (MPT)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:M
Last Name:MAZUREK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W153N11856 DANIELS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-2066
Mailing Address - Country:US
Mailing Address - Phone:262-250-1255
Mailing Address - Fax:
Practice Address - Street 1:W63N541 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1917
Practice Address - Country:US
Practice Address - Phone:262-375-2195
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5415-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0002Medicare ID - Type Unspecified