Provider Demographics
NPI:1043426307
Name:WILLIAMS, BETHANY C
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:C
Last Name:WILLIAMS
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 1:15095 PERLITE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-9614
Mailing Address - Country:US
Mailing Address - Phone:775-829-4700
Mailing Address - Fax:
Practice Address - Street 1:3700 GRANT DR
Practice Address - Street 2:STE A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5309
Practice Address - Country:US
Practice Address - Phone:775-829-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0361225100000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003416422Medicaid