Individual
JENNY BAZELAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
674 MAYA SUSAN LOOP, APOPKA, FL 32712-1804
(321) 305-0279
Mailing address
674 MAYA SUSAN LOOP, APOPKA, FL 32712-1804
(321) 305-0279
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
A4440
MD
225200000X
Physical Therapy Assistant
Primary
PTA19745
FL
Other
Enumeration date
05/13/2016
Last updated
05/13/2016
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