Provider Demographics
NPI:1033496609
Name:BEISNER, BETHANNE J (RMT)
Entity Type:Individual
Prefix:
First Name:BETHANNE
Middle Name:J
Last Name:BEISNER
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 S HANNIBAL WAY
Mailing Address - Street 2:#216
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11275 E MISSISSIPPI AVE
Practice Address - Street 2:1S8
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3263
Practice Address - Country:US
Practice Address - Phone:303-263-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6542225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist