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General NPI Number Information
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NPI Number | 1053093161
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Entity Type | Individual
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Provider Name | JACOB MUZZARELLI DPT
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Gender | Male
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 25229 S SUN LAKES BLVD
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City | SUN LAKES
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State | AZ
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Zip | 85248-6453
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Country | US
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Telephone | 480-883-6734
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Fax |
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Provider Business Mailing Address
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Address Line | 483 W GASCON RD
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-5467
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Country | US
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Telephone | 954-224-4906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | LPT-33116
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License Number State | AZ
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