Healthcare Provider Details

I. General information

NPI: 1073380622
Provider Name (Legal Business Name): MIRIAM HAZLETT PT, DPT, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 E POWELL RD
LEWIS CENTER OH
43035-8619
US

IV. Provider business mailing address

1087 PARKLEIGH RD
COLUMBUS OH
43220-4041
US

V. Phone/Fax

Practice location:
  • Phone: 614-981-2065
  • Fax:
Mailing address:
  • Phone: 812-470-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020651
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: