Provider Demographics
NPI:1366017592
Name:IRVING, ELIZABETH HAZEBROEK (ATC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HAZEBROEK
Last Name:IRVING
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 KERNEWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4714
Mailing Address - Country:US
Mailing Address - Phone:443-462-8157
Mailing Address - Fax:
Practice Address - Street 1:309 KERNEWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4714
Practice Address - Country:US
Practice Address - Phone:443-462-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer