Provider Demographics
NPI:1164910873
Name:HAZEL, JAMES AUSTIN (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:AUSTIN
Last Name:HAZEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 COUNTY ROAD 1510
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-8650
Mailing Address - Country:US
Mailing Address - Phone:423-847-7743
Mailing Address - Fax:
Practice Address - Street 1:241 COUNTY ROAD 1510
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-8650
Practice Address - Country:US
Practice Address - Phone:423-847-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist