Provider Demographics
NPI:1376244608
Name:HAMAD, GAZAL (LMT)
Entity Type:Individual
Prefix:
First Name:GAZAL
Middle Name:
Last Name:HAMAD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 SPRING GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3411
Mailing Address - Country:US
Mailing Address - Phone:216-440-9777
Mailing Address - Fax:
Practice Address - Street 1:1567 SPRING GARDEN AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3411
Practice Address - Country:US
Practice Address - Phone:216-440-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33020070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist