Provider Demographics
NPI:1265944532
Name:BUZOLLO, MARIA LUCIA (LMT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUCIA
Last Name:BUZOLLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2758
Mailing Address - Country:US
Mailing Address - Phone:907-351-7993
Mailing Address - Fax:
Practice Address - Street 1:325 A ST STE 3
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1970
Practice Address - Country:US
Practice Address - Phone:907-351-7993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106322225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist