Provider Demographics
NPI:1659720795
Name:KIZZIAR, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KIZZIAR
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 1:300 PROSPECT AVE
Mailing Address - Street 2:H21
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-4003
Mailing Address - Country:US
Mailing Address - Phone:501-622-3336
Mailing Address - Fax:501-623-7654
Practice Address - Street 1:300 PROSPECT AVE
Practice Address - Street 2:H21
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4003
Practice Address - Country:US
Practice Address - Phone:501-622-3336
Practice Address - Fax:501-623-7654
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist