Provider Demographics
NPI:1619455532
Name:HAZELWOOD, BRIDGET (PT DPT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:HAZELWOOD
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9852 KENTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24594-3222
Mailing Address - Country:US
Mailing Address - Phone:434-489-2638
Mailing Address - Fax:
Practice Address - Street 1:174 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541
Practice Address - Country:US
Practice Address - Phone:434-797-1504
Practice Address - Fax:434-797-1506
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist