Provider Demographics
NPI:1740548510
Name:ANDERSON, HAZEL D (PT)
Entity type:Individual
Prefix:MISS
First Name:HAZEL
Middle Name:D
Last Name:ANDERSON
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 1:5000 BEE CAVE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5266
Mailing Address - Country:US
Mailing Address - Phone:512-329-6617
Mailing Address - Fax:512-329-6772
Practice Address - Street 1:5000 BEE CAVE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5266
Practice Address - Country:US
Practice Address - Phone:512-329-6617
Practice Address - Fax:512-329-6772
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist