Individual provider · NPI-1

Roniphael Bazile

Specialist/Technologist, Athletic Trainer · Brockton, MA

NPI number1174295968
StatusActive
Last updated in NPPESSep 30, 2021

Details

NPI
1174295968
Entity type
Individual (NPI-1)
Name
Roniphael Bazile
Sex
Male
Sole proprietor
No
Enumeration date
Sep 30, 2021
Certification date
Sep 30, 2021
Last updated
Sep 30, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer––Yes

Practice location

24 Angerer Ave
Brockton, MA 02302-1034

Phone 857-800-6112

Mailing address

24 Angerer Ave
Brockton, MA 02302-1034

Phone 857-800-6112

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