Provider Demographics
NPI:1396941738
Name:ROWELL-HAZEL, SHONDA MARIE (PT)
Entity type:Individual
Prefix:
First Name:SHONDA
Middle Name:MARIE
Last Name:ROWELL-HAZEL
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:2431 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1519
Mailing Address - Country:US
Mailing Address - Phone:806-771-8008
Mailing Address - Fax:806-771-8009
Practice Address - Street 1:4138 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407
Practice Address - Country:US
Practice Address - Phone:806-780-2329
Practice Address - Fax:806-780-2330
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2018-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1091056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JM153OtherBCBS
TX3855416801Medicaid