Individual
ELIZABETH A DAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
6640 JOHNSON DR, MISSION, KS 66202-2617
(913) 384-5810
(913) 384-0719
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-2564
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1103763
KS
225100000X
Physical Therapist
2006021634
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37204058
BCBS KC
—
01
—
KA2868025
MEDICARE PTAN
KS
01
—
MA4370060
MEDICARE PTAN
MO
Enumeration date
06/06/2006
Last updated
11/21/2017
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