Provider Demographics
NPI:1750107934
Name:HAZEL, BRENDA LYNN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:HAZEL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6905 MEADOWVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0533
Mailing Address - Country:US
Mailing Address - Phone:337-515-8901
Mailing Address - Fax:
Practice Address - Street 1:4080 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2439
Practice Address - Country:US
Practice Address - Phone:337-494-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA02603R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist