Provider Demographics
NPI:1033651997
Name:PEARSON, BETHANY ESTELLE (PT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ESTELLE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ESTELLE
Other - Last Name:MULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:7344 FODOR RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8336
Practice Address - Country:US
Practice Address - Phone:614-855-2570
Practice Address - Fax:614-855-2580
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist