Provider Demographics
NPI:1295707503
Name:BAZLUKI, JAMES M (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:BAZLUKI
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SARABANDE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5195
Mailing Address - Country:US
Mailing Address - Phone:919-234-9280
Mailing Address - Fax:
Practice Address - Street 1:638 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4224
Practice Address - Country:US
Practice Address - Phone:919-291-6445
Practice Address - Fax:919-460-3573
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer