Provider Demographics
NPI:1881839447
Name:TAPIC, HAZEL LUCANAS
Entity Type:Individual
Prefix:MISS
First Name:HAZEL
Middle Name:LUCANAS
Last Name:TAPIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 MANILLA ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4150
Mailing Address - Country:US
Mailing Address - Phone:805-765-7501
Mailing Address - Fax:
Practice Address - Street 1:54 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5719
Practice Address - Country:US
Practice Address - Phone:805-765-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist