Provider Demographics
NPI:1730115635
Name:MARTHE, HAZEL (PT)
Entity Type:Individual
Prefix:MISS
First Name:HAZEL
Middle Name:
Last Name:MARTHE
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 1:11696 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5610
Mailing Address - Country:US
Mailing Address - Phone:954-438-9743
Mailing Address - Fax:
Practice Address - Street 1:18300 NW 62ND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33015-8200
Practice Address - Country:US
Practice Address - Phone:305-474-4960
Practice Address - Fax:305-474-4962
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3749ZMedicare ID - Type Unspecified