Provider Demographics
NPI:1134931173
Name:AZEH, PATRICIA MARCIANO (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARCIANO
Last Name:AZEH
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N CALHOUN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5902
Mailing Address - Country:US
Mailing Address - Phone:414-573-5771
Mailing Address - Fax:
Practice Address - Street 1:405 N CALHOUN RD STE 102
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5902
Practice Address - Country:US
Practice Address - Phone:414-573-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17755-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist