Healthcare Provider Details

I. General information

NPI: 1699204974
Provider Name (Legal Business Name): BETH ELLEN IZBOTSKY PT, MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA BLVD
BURBANK CA
91505
US

IV. Provider business mailing address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

V. Phone/Fax

Practice location:
  • Phone: 818-802-4038
  • Fax:
Mailing address:
  • Phone: 818-802-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number29192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: