1730857194 NPI number — MARIAH BAESEL MEDICAL MASSAGE THER

Table of content: MARIAH BAESEL MEDICAL MASSAGE THER (NPI 1730857194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730857194 NPI number — MARIAH BAESEL MEDICAL MASSAGE THER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAESEL
Provider First Name:
MARIAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MEDICAL MASSAGE THER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAESEL
Provider Other First Name:
MARIAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MEDICAL EXERCISE REH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730857194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8410 BLUEVINE SKY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAND O LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34637-7651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-778-8135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8410 BLUEVINE SKY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAND O LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34637-7651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-778-8135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com