Healthcare Provider Details

I. General information

NPI: 1588319941
Provider Name (Legal Business Name): HAZEL VAZIRANI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINDSEY LN STE A
SAINT MARYS GA
31558-1727
US

IV. Provider business mailing address

PO BOX 949
ROME GA
30162-0949
US

V. Phone/Fax

Practice location:
  • Phone: 912-729-1333
  • Fax: 912-729-5259
Mailing address:
  • Phone: 912-729-1333
  • Fax: 912-729-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12901
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058313T
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: