Provider Demographics
NPI:1750121042
Name:BEZYUKEVICH, DIANA V (LMT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:V
Last Name:BEZYUKEVICH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 THREE ISLANDS BLVD APT 1407
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2850
Mailing Address - Country:US
Mailing Address - Phone:786-399-2894
Mailing Address - Fax:
Practice Address - Street 1:600 THREE ISLANDS BLVD APT 1407
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2850
Practice Address - Country:US
Practice Address - Phone:786-399-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99612225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist