Provider Demographics
NPI:1386723948
Name:HAZUDA, SCOTT S (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:S
Last Name:HAZUDA
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 RIVA RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7428
Mailing Address - Country:US
Mailing Address - Phone:410-573-2530
Mailing Address - Fax:410-573-2536
Practice Address - Street 1:2629 RIVA RD STE 114
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7428
Practice Address - Country:US
Practice Address - Phone:410-573-2530
Practice Address - Fax:410-573-2536
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD435138000Medicaid