MEDICARE: JASON HAZELETT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05006433A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P002239911	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346247681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON HAZELETT PT

Provider Business Mailing Address
First Line	:	5800 FAIRFIELD AVE STE 150
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-3450
Country	:	US
Telephone Number	:	260-744-5585
Fax Number	:	260-744-5586

Provider Business Practice Location Address
First Line	:	5800 FAIRFIELD AVE STE 150
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-3450
Country	:	US
Telephone Number	:	260-744-5585
Fax Number	:	260-744-5586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	11/21/2008

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Directions to “ JASON HAZELETT PT” Practice Location

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