Healthcare Provider Details

I. General information

NPI: 1215680731
Provider Name (Legal Business Name): LYNSEY DIAN BIZZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CYPRESS CREEK RD STE B1
CEDAR PARK TX
78613-4477
US

IV. Provider business mailing address

7505 N LOOP 1604 E STE 101
LIVE OAK TX
78233-2604
US

V. Phone/Fax

Practice location:
  • Phone: 512-918-0444
  • Fax:
Mailing address:
  • Phone: 210-590-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: