Provider Demographics
NPI:1548587157
Name:BAZZLE, SARAH REBECCA (LMBT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:REBECCA
Last Name:BAZZLE
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:REBECCA
Other - Last Name:MANZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3705 EASTOVER RDG RD
Mailing Address - Street 2:#1415
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1585
Mailing Address - Country:US
Mailing Address - Phone:704-770-6341
Mailing Address - Fax:
Practice Address - Street 1:447 S SHARON AMITY RD
Practice Address - Street 2:STE 225
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2836
Practice Address - Country:US
Practice Address - Phone:704-806-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist