Individual
BEVERLY DAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5980 W 71ST ST STE 201, INDIANAPOLIS, IN 46278-1785
(317) 388-0800
Mailing address
405 S MORRISON RD APT 63, MUNCIE, IN 47304-4011
(812) 620-3883
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008389A
IN
Other
Enumeration date
09/01/2006
Last updated
07/08/2007
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