Provider Demographics
NPI:1992874945
Name:HAZAMA, DEAN (MPT)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:HAZAMA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-5046
Mailing Address - Country:US
Mailing Address - Phone:310-210-3044
Mailing Address - Fax:
Practice Address - Street 1:1856 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-5046
Practice Address - Country:US
Practice Address - Phone:310-210-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO PT 8577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist