Provider Demographics
NPI:1134929441
Name:HASIN, KAZI (PTA)
Entity type:Individual
Prefix:
First Name:KAZI
Middle Name:
Last Name:HASIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S COUNTRY CLUB DR APT 2068
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3554
Mailing Address - Country:US
Mailing Address - Phone:480-334-8477
Mailing Address - Fax:
Practice Address - Street 1:5040 N 15TH AVE STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3332
Practice Address - Country:US
Practice Address - Phone:602-285-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA--014967225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant