MEDICARE: ANTONIO E MAZU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT101297	TX

General Provider Information

NPI Number	:	1245413418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO E MAZU

Provider Business Mailing Address
First Line	:	10925 BRIAR FOREST DR
Second Line	:	# 2052
City	:	HOUSTON
State	:	TX
Zip	:	77042-2255
Country	:	US
Telephone Number	:	832-242-2614
Fax Number	:

Provider Business Practice Location Address
First Line	:	10925 BRIAR FOREST DR
Second Line	:	# 2052
City	:	HOUSTON
State	:	TX
Zip	:	77042-2255
Country	:	US
Telephone Number	:	832-242-2614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/11/2007

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Directions to “ ANTONIO E MAZU ” Practice Location

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