Provider Demographics
NPI:1285106914
Name:HAZARD, KATHERINE A (LPTA)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:A
Last Name:HAZARD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2003
Mailing Address - Country:US
Mailing Address - Phone:419-344-6911
Mailing Address - Fax:
Practice Address - Street 1:5757 WHITEFORD RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1632
Practice Address - Country:US
Practice Address - Phone:419-882-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA005533225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant