Provider Demographics
NPI:1588330708
Name:MAYS, JAZZARE (PT)
Entity type:Individual
Prefix:
First Name:JAZZARE
Middle Name:
Last Name:MAYS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 NORWICH AVE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1274
Mailing Address - Country:US
Mailing Address - Phone:860-537-3014
Mailing Address - Fax:860-537-1420
Practice Address - Street 1:171 NORWICH AVE
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1274
Practice Address - Country:US
Practice Address - Phone:860-537-3014
Practice Address - Fax:860-537-1420
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE