Provider Demographics
NPI:1568512473
Name:BLIX, SARA LAUZZE (DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LAUZZE
Last Name:BLIX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 JESSIE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-2101
Mailing Address - Country:US
Mailing Address - Phone:941-321-9767
Mailing Address - Fax:
Practice Address - Street 1:777 S PALM AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7770
Practice Address - Country:US
Practice Address - Phone:941-321-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT23118OtherSTATE LICENSE NUMBER
FLAB300YMedicare PIN