Provider Demographics
NPI:1215680731
Name:BIZZELL, LYNSEY DIAN
Entity type:Individual
Prefix:
First Name:LYNSEY
Middle Name:DIAN
Last Name:BIZZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 N LOOP 1604 E STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2604
Mailing Address - Country:US
Mailing Address - Phone:210-590-4000
Mailing Address - Fax:
Practice Address - Street 1:109 CYPRESS CREEK RD STE B1
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4477
Practice Address - Country:US
Practice Address - Phone:512-918-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist