Provider Demographics
NPI:1750667960
Name:BELIZAR, KIMBERLY DENISE (PT)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DENISE
Last Name:BELIZAR
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 1:12 MIDDLE CT
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1914
Mailing Address - Country:US
Mailing Address - Phone:631-275-1505
Mailing Address - Fax:
Practice Address - Street 1:12 MIDDLE CT
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1914
Practice Address - Country:US
Practice Address - Phone:631-275-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist