Provider Demographics
NPI:1225316896
Name:LIM, HAZEL (PT)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HEIGHTS LN APT 25C
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7635
Mailing Address - Country:US
Mailing Address - Phone:267-988-4512
Mailing Address - Fax:
Practice Address - Street 1:301 HEIGHTS LN APT 25C
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7635
Practice Address - Country:US
Practice Address - Phone:267-988-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist