Provider Demographics
NPI:1275808107
Name:STO TOMAS, HAZEL KATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:HAZEL KATHERINE
Middle Name:
Last Name:STO TOMAS
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 1:38 DEERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1805
Mailing Address - Country:US
Mailing Address - Phone:201-968-6112
Mailing Address - Fax:201-561-0158
Practice Address - Street 1:1980 AMSTERDAM AVE
Practice Address - Street 2:UNIT 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5058
Practice Address - Country:US
Practice Address - Phone:212-740-2049
Practice Address - Fax:201-561-0158
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-10
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist