Provider Demographics
NPI:1053093161
Name:MUZZARELLI, JACOB (DPT)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:MUZZARELLI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 W GASCON RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5467
Mailing Address - Country:US
Mailing Address - Phone:954-224-4906
Mailing Address - Fax:
Practice Address - Street 1:25229 S SUN LAKES BLVD
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-6453
Practice Address - Country:US
Practice Address - Phone:480-883-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-33116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist