Provider Demographics
NPI:1174295968
Name:BAZILE, RONIPHAEL
Entity Type:Individual
Prefix:
First Name:RONIPHAEL
Middle Name:
Last Name:BAZILE
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 1:24 ANGERER AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1034
Mailing Address - Country:US
Mailing Address - Phone:857-800-6112
Mailing Address - Fax:
Practice Address - Street 1:24 ANGERER AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1034
Practice Address - Country:US
Practice Address - Phone:857-800-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer