Provider Demographics
NPI:1134016082
Name:MAZUREK, KAGEN TROY
Entity type:Individual
Prefix:
First Name:KAGEN
Middle Name:TROY
Last Name:MAZUREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20915 WILDERNESS OAK APT 5410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2607
Mailing Address - Country:US
Mailing Address - Phone:830-992-5892
Mailing Address - Fax:
Practice Address - Street 1:20915 WILDERNESS OAK APT 5410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2607
Practice Address - Country:US
Practice Address - Phone:830-992-5892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT145643225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist