Healthcare Provider Details

I. General information

NPI: 1134009731
Provider Name (Legal Business Name): JILL HAZEN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CHERRY LN
BETHLEHEM PA
18015-9540
US

IV. Provider business mailing address

2301 CHERRY LN
BETHLEHEM PA
18015-9540
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-5025
  • Fax: 484-526-5030
Mailing address:
  • Phone: 484-526-5025
  • Fax: 484-526-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI002541
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: