Provider Demographics
NPI:1396033197
Name:HAZELTON, BRYANT D (PT)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:D
Last Name:HAZELTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:74 VERMONT ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-3011
Mailing Address - Country:US
Mailing Address - Phone:802-899-5200
Mailing Address - Fax:802-899-5800
Practice Address - Street 1:184 ROUTE 7 S
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3602
Practice Address - Country:US
Practice Address - Phone:802-893-7427
Practice Address - Fax:802-893-7429
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0077317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist