Provider Demographics
NPI:1467714642
Name:BAZZETTA, LORI ANN (MT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:BAZZETTA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25267 FORTUNA ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3642
Mailing Address - Country:US
Mailing Address - Phone:586-747-1712
Mailing Address - Fax:
Practice Address - Street 1:25267 FORTUNA ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3642
Practice Address - Country:US
Practice Address - Phone:586-747-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist