Provider Demographics
NPI:1699882381
Name:HANZEL, RICKI SUE (PT, DPT, MSPT, COMT)
Entity type:Individual
Prefix:
First Name:RICKI
Middle Name:SUE
Last Name:HANZEL
Suffix:
Gender:F
Credentials:PT, DPT, MSPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 OCEAN CLUB BLVD
Mailing Address - Street 2:APT. 106
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-3945
Mailing Address - Country:US
Mailing Address - Phone:954-804-8305
Mailing Address - Fax:754-400-8912
Practice Address - Street 1:2721 OCEAN CLUB BLVD
Practice Address - Street 2:106
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-3945
Practice Address - Country:US
Practice Address - Phone:954-804-8305
Practice Address - Fax:754-400-8912
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI2939OtherHAWAII PT LICENSE
FL20752OtherLICENSE #
FLBS765Medicare PIN