MEDICARE: PATRICE HAZAN DPT

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	2251G0304X	Geriatric Physical Therapist	3027	SC

General Provider Information

NPI Number	:	1750784138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE HAZAN DPT

Provider Business Mailing Address
First Line	:	205 SHADOWBROOKE CT
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-5184
Country	:	US
Telephone Number	:	864-525-2654
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 NE MAIN ST
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-2041
Country	:	US
Telephone Number	:	864-525-2654
Fax Number	:

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

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	01/04/2015

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