Provider Demographics
NPI:1841178589
Name:HAZEN, KATHLEEN JOY ELLIS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JOY ELLIS
Last Name:HAZEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:KATE
Other - Middle Name:JOY ELLIS
Other - Last Name:HAZEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2515 NE OVERLOOK DR APT 326
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7615
Mailing Address - Country:US
Mailing Address - Phone:509-703-9506
Mailing Address - Fax:
Practice Address - Street 1:5289 NE ELAM YOUNG PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7551
Practice Address - Country:US
Practice Address - Phone:503-747-5359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist