Healthcare Provider Details

I. General information

NPI: 1063028215
Provider Name (Legal Business Name): BETHANY HOPE KUZMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MINGES CREEK PL
BATTLE CREEK MI
49015-4201
US

IV. Provider business mailing address

8152 ALLISON LN
BATTLE CREEK MI
49014-9580
US

V. Phone/Fax

Practice location:
  • Phone: 269-979-6365
  • Fax: 269-979-6374
Mailing address:
  • Phone: 269-274-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502006195
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: