Healthcare Provider Details

I. General information

NPI: 1285106914
Provider Name (Legal Business Name): KATHERINE A HAZARD LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WHITEFORD RD
SYLVANIA OH
43560-1632
US

IV. Provider business mailing address

401 W BROADWAY ST
MAUMEE OH
43537-2003
US

V. Phone/Fax

Practice location:
  • Phone: 419-882-1875
  • Fax:
Mailing address:
  • Phone: 419-344-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA005533
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: