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NPI Code Detail

MEDICARE: MRS. CARMEN LAZENBY LMBT #5031

MEDICARE: MRS. CARMEN LAZENBY LMBT #5031
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
1225700000XMassage Therapist5031NC

General Provider Information

NPI Number : 1679714521
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARMEN LAZENBY LMBT #5031
Provider Business Mailing Address
First Line : 4514 CAPSTONE DR
Second Line :
City : MONROE
State : NC
Zip : 28110-7673
Country : US
Telephone Number : 704-221-5872
Fax Number :
Provider Business Practice Location Address
First Line : 2325 HANOVER DR
Second Line :
City : MONROE
State : NC
Zip : 28110-0450
Country : US
Telephone Number : 704-282-4758
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2009
Last Update Date : 03/23/2009

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Directions to “ MRS. CARMEN LAZENBY LMBT #5031” Practice Location

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