Provider Demographics
NPI:1003238775
Name:YOUNGBLOOD, BETHANY (PT)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6890
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47719-0890
Mailing Address - Country:US
Mailing Address - Phone:812-491-3856
Mailing Address - Fax:812-491-1269
Practice Address - Street 1:402 S RICHLAND CREEK DR
Practice Address - Street 2:STE A
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-9570
Practice Address - Country:US
Practice Address - Phone:812-753-4549
Practice Address - Fax:812-753-4552
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003264A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist