Provider Demographics
NPI:1396355228
Name:ROZIER, RICARDO D JR (LMBT NC #16356)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:D
Last Name:ROZIER
Suffix:JR
Gender:M
Credentials:LMBT NC #16356
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2116 YAGER CREEK DR APT O
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6347
Mailing Address - Country:US
Mailing Address - Phone:203-906-7040
Mailing Address - Fax:
Practice Address - Street 1:2116 YAGER CREEK DR APT O
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6347
Practice Address - Country:US
Practice Address - Phone:203-906-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16356225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty