Provider Demographics
NPI:1568596237
Name:BLEWETT, BEATRICE GAZDA (PT)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:GAZDA
Last Name:BLEWETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:GAZDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8 BELCANTO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5157
Mailing Address - Country:US
Mailing Address - Phone:949-859-3218
Mailing Address - Fax:949-707-5706
Practice Address - Street 1:23271 VERDUGO DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1347
Practice Address - Country:US
Practice Address - Phone:949-707-5555
Practice Address - Fax:949-707-5706
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic