Provider Demographics
NPI:1104522010
Name:HEZEL, ALLISON (CTRS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HEZEL
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:ALLY
Other - Middle Name:
Other - Last Name:HEZEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CTRS
Mailing Address - Street 1:16804 DANCING AVA UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3499
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34768225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist