Provider Demographics
NPI:1538192091
Name:HAZELCORN, MARIANA J (PT)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:J
Last Name:HAZELCORN
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 1:301 CAMINO GARDENS BLVD
Mailing Address - Street 2:201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5823
Mailing Address - Country:US
Mailing Address - Phone:561-394-8770
Mailing Address - Fax:561-394-3615
Practice Address - Street 1:301 CAMINO GARDENS BLVD
Practice Address - Street 2:201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5823
Practice Address - Country:US
Practice Address - Phone:561-394-8770
Practice Address - Fax:561-394-3615
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 3901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist