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General NPI Number Information
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NPI Number | 1285859066
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Entity Type | Individual
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Provider Name | JOAN MARLAYNE BAZELLA PT
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 09/05/2008
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Provider Practice Location Address
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Address Line | 480 W 78TH ST
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City | CHANHASSEN
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State | MN
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Zip | 55317-4527
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Country | US
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Telephone | 952-906-7880
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Fax |
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Provider Business Mailing Address
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Address Line | 115 S CEDAR ST
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City | CHASKA
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State | MN
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Zip | 55318-1837
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Country | US
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Telephone | 952-448-7036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7744
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License Number State | MN
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