Healthcare Provider Details

I. General information

NPI: 1124962519
Provider Name (Legal Business Name): JAMIE BOLTON LAZZERI CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE HISAKO BOLTON

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8107 LAKE PLEASANT DR
SPRINGFIELD VA
22153-3008
US

IV. Provider business mailing address

8107 LAKE PLEASANT DR
SPRINGFIELD VA
22153-3008
US

V. Phone/Fax

Practice location:
  • Phone: 571-409-9201
  • Fax:
Mailing address:
  • Phone: 571-409-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019007367
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: