Provider Demographics
NPI:1124372842
Name:PLOUGH, HAZEN (DPT)
Entity Type:Individual
Prefix:
First Name:HAZEN
Middle Name:
Last Name:PLOUGH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:1830 BICKFORD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1749
Practice Address - Country:US
Practice Address - Phone:360-568-7774
Practice Address - Fax:360-568-7779
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60297952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0302307OtherL & I
WA0302299OtherL & I
WA0302347OtherL & I
WA0302366OtherL & I
WA0302299OtherL & I
WAG8915465Medicare PIN
WA0302307OtherL & I
WAG8915406Medicare PIN