Provider Demographics
NPI:1558103473
Name:BEDFORD, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BEDFORD
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 1:280 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EASTABOGA
Mailing Address - State:AL
Mailing Address - Zip Code:36260-5130
Mailing Address - Country:US
Mailing Address - Phone:256-419-8601
Mailing Address - Fax:
Practice Address - Street 1:5735 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36613-2842
Practice Address - Country:US
Practice Address - Phone:251-442-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer