Provider Demographics
NPI:1396192027
Name:HAZAMY, BRANDI (PT)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:
Last Name:HAZAMY
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 1:16125 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2948
Mailing Address - Country:US
Mailing Address - Phone:734-285-1070
Mailing Address - Fax:734-285-1073
Practice Address - Street 1:16125 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2948
Practice Address - Country:US
Practice Address - Phone:734-285-1070
Practice Address - Fax:734-285-1073
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist