Provider Demographics
NPI:1598880981
Name:HAZEN PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HAZEN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBR
Authorized Official - Phone:765-282-3486
Mailing Address - Street 1:1705 N BOB O LINK DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1705 N BOB O LINK DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6616
Practice Address - Country:US
Practice Address - Phone:765-282-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200871400AMedicaid
IN156632Medicare PIN