Provider Demographics
NPI:1861634438
Name:WAZEN, LAURA JANE (DPT)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JANE
Last Name:WAZEN
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 1:950 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7840
Mailing Address - Country:US
Mailing Address - Phone:941-404-4567
Mailing Address - Fax:
Practice Address - Street 1:950 S TAMIAMI TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7840
Practice Address - Country:US
Practice Address - Phone:941-404-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist