Provider Demographics
NPI:1518155936
Name:DELOS REYES, HAZEL LYN (PT)
Entity type:Individual
Prefix:MISS
First Name:HAZEL
Middle Name:LYN
Last Name:DELOS REYES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 GLEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-1111
Mailing Address - Country:US
Mailing Address - Phone:817-233-2153
Mailing Address - Fax:
Practice Address - Street 1:3301 VIEW ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-2425
Practice Address - Country:US
Practice Address - Phone:817-531-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist