Provider Demographics
NPI:1487816138
Name:PRACHT, HAZEL ALICE (PT)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:ALICE
Last Name:PRACHT
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 1:2812 MARGOT AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1606
Mailing Address - Country:US
Mailing Address - Phone:919-562-1172
Mailing Address - Fax:
Practice Address - Street 1:2812 MARGOT AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-1606
Practice Address - Country:US
Practice Address - Phone:919-562-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist