Provider Demographics
NPI:1508138009
Name:TRINIDAD, HAZEL SHERIL (PT)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:SHERIL
Last Name:TRINIDAD
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 1:2855 MILLER DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8091
Mailing Address - Country:US
Mailing Address - Phone:574-941-1055
Mailing Address - Fax:574-941-1083
Practice Address - Street 1:2855 MILLER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8091
Practice Address - Country:US
Practice Address - Phone:574-941-1055
Practice Address - Fax:574-941-1083
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008293A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist