Provider Demographics
NPI:1073338117
Name:HATZFELD, KALEN (DPT)
Entity type:Individual
Prefix:
First Name:KALEN
Middle Name:
Last Name:HATZFELD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17205 FLANAGAN LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-9448
Mailing Address - Country:US
Mailing Address - Phone:949-285-1720
Mailing Address - Fax:
Practice Address - Street 1:9900 INDIANA AVE STE 8
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5498
Practice Address - Country:US
Practice Address - Phone:951-376-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist