Provider Demographics
NPI:1033883129
Name:VOSS, BETHANY JAYNE (LMT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JAYNE
Last Name:VOSS
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 1:113 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-7169
Mailing Address - Country:US
Mailing Address - Phone:509-240-0989
Mailing Address - Fax:
Practice Address - Street 1:100 N COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1015
Practice Address - Country:US
Practice Address - Phone:509-520-5716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61095110225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist