Provider Demographics
NPI:1669446704
Name:HATZEL, BRIAN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:HATZEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13061 BLACKHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8304
Mailing Address - Country:US
Mailing Address - Phone:616-293-1146
Mailing Address - Fax:
Practice Address - Street 1:1 CAMPUS DRIVE, GRAND VALLEY STATE UNIVERSITY
Practice Address - Street 2:184-B FIELDHOUSE
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401
Practice Address - Country:US
Practice Address - Phone:616-331-8538
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer