MEDICARE: MRS. BETHANY LYNNE HIZER P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7509	TN
2	225100000X	Physical Therapist	7566	AZ
3	225100000X	Physical Therapist	2002003815	MO

General Provider Information

NPI Number	:	1396942330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY LYNNE HIZER P.T.

Provider Business Mailing Address
First Line	:	3400 LAKE MARY RD
Second Line	:	21204
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-9392
Country	:	US
Telephone Number	:	928-774-1944
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 LAKE MARY RD
Second Line	:	21204
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-9392
Country	:	US
Telephone Number	:	928-774-1944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	07/08/2007

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