Provider Demographics
NPI:1174269302
Name:CAZEAU, VERONIE REGINA (LMT)
Entity Type:Individual
Prefix:
First Name:VERONIE
Middle Name:REGINA
Last Name:CAZEAU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 W THOMPSON ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4531
Mailing Address - Country:US
Mailing Address - Phone:508-471-6834
Mailing Address - Fax:
Practice Address - Street 1:4920 W THOMPSON ST UNIT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4531
Practice Address - Country:US
Practice Address - Phone:508-471-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG012549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist