Provider Demographics
NPI:1124347190
Name:MAZOR, ROBERT ALAN
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:MAZOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BAHIA VISTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2640
Mailing Address - Country:US
Mailing Address - Phone:941-951-2663
Mailing Address - Fax:941-957-4437
Practice Address - Street 1:2750 BAHIA VISTA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2600
Practice Address - Country:US
Practice Address - Phone:941-951-2663
Practice Address - Fax:941-957-4437
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 24233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist