Provider Demographics
NPI:1326120726
Name:BAZINET, HEATHER A (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:BAZINET
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 LARK AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2547
Mailing Address - Country:US
Mailing Address - Phone:408-513-7851
Mailing Address - Fax:
Practice Address - Street 1:16400 LARK AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2547
Practice Address - Country:US
Practice Address - Phone:408-513-7851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT301060Medicare PIN