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Individual
SHANE EMERSON BAZE
Active
Individual
SHANE EMERSON BAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
60057
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500655109
—
OR
01
—
P01220789
RR MEDICARE
OR
Enumeration date
02/08/2013
Last updated
11/14/2013
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