MEDICARE: MRS. SARAH REBECCA BAZZLE LMBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	4095	NC

General Provider Information

NPI Number	:	1548587157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH REBECCA BAZZLE LMBT

Provider Business Mailing Address
First Line	:	3705 EASTOVER RDG RD
Second Line	:	#1415
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1585
Country	:	US
Telephone Number	:	704-770-6341
Fax Number	:

Provider Business Practice Location Address
First Line	:	447 S SHARON AMITY RD
Second Line	:	STE 225
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2836
Country	:	US
Telephone Number	:	704-806-8380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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