Healthcare Provider Details

I. General information

NPI: 1124372842
Provider Name (Legal Business Name): HAZEN PLOUGH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BICKFORD AVE SUITE 209
SNOHOMISH WA
98290-1749
US

IV. Provider business mailing address

1519 132ND ST SE SUITE A
EVERETT WA
98208-7203
US

V. Phone/Fax

Practice location:
  • Phone: 360-568-7774
  • Fax: 360-568-7779
Mailing address:
  • Phone: 425-357-9380
  • Fax: 425-357-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60297952
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: