Provider Demographics
NPI:1942314653
Name:PARIS, BETTY A (PT)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:PARIS
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 1:15001 SW 31ST CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2622
Mailing Address - Country:US
Mailing Address - Phone:954-465-7445
Mailing Address - Fax:954-370-6957
Practice Address - Street 1:15001 SW 31ST CT
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-2622
Practice Address - Country:US
Practice Address - Phone:954-465-7445
Practice Address - Fax:954-370-6957
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL PT 2109171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBCBS Y5955OtherPHYSICAL THERAPIST