Provider Demographics
NPI:1215205257
Name:PARSON, BETHANY KATHRYN (LMP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:KATHRYN
Last Name:PARSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5361
Mailing Address - Country:US
Mailing Address - Phone:760-884-7111
Mailing Address - Fax:
Practice Address - Street 1:1610 C ST
Practice Address - Street 2:SUITE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3400
Practice Address - Country:US
Practice Address - Phone:360-694-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60168424225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist