CENTER FOR MYOFASCIAL THERAPEUTICS AND AESTHETICS NPI 1932750056

NPI Information

  • NPI: 1932750056
  • Provider Name: CENTER FOR MYOFASCIAL THERAPEUTICS AND AESTHETICS
  • Classification: Nurse Practitioner - 363L00000X
  • Entity Type: Organization
  • Former Legal Business Name: BRAZZALE SURGICAL ASSISTING LLC
  • Address: 9430 WICKER AVE
    SAINT JOHN, IN
    ZIP 46373
  • Phone: (219) 558-8068

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NPI Details

CENTER FOR MYOFASCIAL THERAPEUTICS AND AESTHETICS is a nurse practitioner in Saint John, IN. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. CENTER FOR MYOFASCIAL THERAPEUTICS AND AESTHETICS NPI is 1932750056. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Brazzale Surgical Assisting Llc.

The provider's business location address is:

9430 WICKER AVE
SAINT JOHN, IN
ZIP 46373-400
Phone: (219) 558-8068
Fax: (877) 822-9116

The provider's authorized official is Ariel Brazzale .
The authorized official title is Ceo and has the following contact phone number (219) 669-1034.

The enumeration date for this NPI number is 9/20/2019 and was last updated on 8/21/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1246ZC0007XSpecialist/Technologist, OtherSurgical AssistantNo
2363L00000XNurse PractitionerYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
171013263AOTHERINDIANAINDIANA NURSING BOARD LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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