Provider Demographics
NPI:1366519506
Name:FERRELL, HAZEL MARIA (PT)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:MARIA
Last Name:FERRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CENTRAL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4149
Mailing Address - Country:US
Mailing Address - Phone:606-237-0004
Mailing Address - Fax:606-237-0330
Practice Address - Street 1:411 CENTRAL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4149
Practice Address - Country:US
Practice Address - Phone:606-237-0004
Practice Address - Fax:606-237-0330
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003194225100000X
WV001191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0158213000Medicaid
KY000000258542OtherANTHEM BC BS
WV0158213000Medicaid
KY000000258542OtherANTHEM BC BS