Provider Demographics
NPI:1467769455
Name:BAYZICK, KELLY M (MPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:BAYZICK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BEEBE RUN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-5679
Mailing Address - Country:US
Mailing Address - Phone:856-453-1584
Mailing Address - Fax:856-453-1486
Practice Address - Street 1:310 BEEBE RUN RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-5679
Practice Address - Country:US
Practice Address - Phone:856-453-1584
Practice Address - Fax:856-453-1486
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00417600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist