Individual
JOAN MARLAYNE BAZELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
480 W 78TH ST, CHANHASSEN, MN 55317-4527
(952) 906-7880
Mailing address
115 S CEDAR ST, CHASKA, MN 55318-1837
(952) 448-7036
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7744
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6B344LO
BCBS MN
MN
Enumeration date
04/16/2007
Last updated
09/05/2008
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