Provider Demographics
NPI:1124300546
Name:MARAZON, MICAH OWEN (DPT)
Entity type:Individual
Prefix:MR
First Name:MICAH
Middle Name:OWEN
Last Name:MARAZON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3657 CORTEZ RD W STE 110
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3171
Mailing Address - Country:US
Mailing Address - Phone:941-780-0867
Mailing Address - Fax:941-275-6382
Practice Address - Street 1:18900 N TAMIAMI TRL STE A5
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7312
Practice Address - Country:US
Practice Address - Phone:239-451-4922
Practice Address - Fax:239-451-4921
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist