Individual
ELIZABETH A DAZE
Active
Individual
ELIZABETH A DAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
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
Update your record
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