Provider Demographics
NPI:1063028215
Name:KUZMA, BETHANY HOPE
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:HOPE
Last Name:KUZMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 ALLISON LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-9580
Mailing Address - Country:US
Mailing Address - Phone:269-274-9148
Mailing Address - Fax:
Practice Address - Street 1:75 MINGES CREEK PL
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4201
Practice Address - Country:US
Practice Address - Phone:269-979-6365
Practice Address - Fax:269-979-6374
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502006195225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant