MEDICARE: HAZEN S HUNT LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	7493910-4701	UT
2	225700000X	Massage Therapist	7493910-4701	UT

General Provider Information

NPI Number	:	1316254311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAZEN S HUNT LMT

Provider Business Mailing Address
First Line	:	4669 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-3072
Country	:	US
Telephone Number	:	801-913-1783
Fax Number	:

Provider Business Practice Location Address
First Line	:	4669 W 3500 S STE 1
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-3077
Country	:	US
Telephone Number	:	801-913-1783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2010
Last Update Date	:	04/08/2011

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Directions to “ HAZEN S HUNT LMT” Practice Location

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