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General NPI Number Information
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NPI Number | 1841148624
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Entity Type | Individual
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Provider Name | JOSE MARCELO E SOUZA MAFRA PT
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Gender | Male
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 102 S BONAVENTURE AVE
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City | TRINIDAD
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State | CO
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Zip | 81082-2054
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Country | US
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Telephone | 719-846-8072
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Fax | 710-846-8071
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Provider Business Mailing Address
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Address Line | 7620 GRIZZLY ROSE WAY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-5501
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Country | US
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Telephone | 719-846-8072
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Fax | 719-846-8071
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PTL.0016237
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License Number State | CO
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