Provider Demographics
NPI:1689154502
Name:HAZARD, NYLAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NYLAH
Middle Name:
Last Name:HAZARD
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 1:1343 LABURNUM AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3488
Mailing Address - Country:US
Mailing Address - Phone:707-364-5159
Mailing Address - Fax:
Practice Address - Street 1:552 VALLOMBROSA AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4038
Practice Address - Country:US
Practice Address - Phone:530-345-1993
Practice Address - Fax:888-511-3977
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist