Basic Information
| Provider Information | |||||||||
| NPI: | 1841859824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAZEL | ||||||||
| FirstName: | PHALEN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4070 WOODCREST LN | ||||||||
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| City: | COLUMBIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175129602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174495079 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2829 LITITZ PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176013396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175693211 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2019 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | TE012112 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.