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General NPI Number Information
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NPI Number | 1861367864
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Entity Type | Individual
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Provider Name | HAZEN MICHAEL PETIT DPT
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Gender | Male
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Dates
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Enumeration Date | 10/08/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 8550 NAAB RD STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2086
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Country | US
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Telephone | 317-338-3364
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Fax |
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Provider Business Mailing Address
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Address Line | 5129 LEMANS DR APT B7
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-5230
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Country | US
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Telephone | 513-827-7463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 99133261A
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License Number State | IN
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