Provider Demographics
NPI:1396942330
Name:HIZER, BETHANY LYNNE (PT)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LYNNE
Last Name:HIZER
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 1:3400 LAKE MARY RD
Mailing Address - Street 2:21204
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9392
Mailing Address - Country:US
Mailing Address - Phone:928-774-1944
Mailing Address - Fax:
Practice Address - Street 1:3400 LAKE MARY RD
Practice Address - Street 2:21204
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-9392
Practice Address - Country:US
Practice Address - Phone:928-774-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7509225100000X
AZ7566225100000X
MO2002003815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist