Provider Demographics
NPI:1538795505
Name:BEZY, AMY LYNN (LMT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BEZY
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 1:525 PONTIAC ST APT 21
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4800
Mailing Address - Country:US
Mailing Address - Phone:248-917-1192
Mailing Address - Fax:
Practice Address - Street 1:525 PONTIAC ST APT 21
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-4800
Practice Address - Country:US
Practice Address - Phone:248-917-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004757225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist