Provider Demographics
NPI:1215227954
Name:ADLER, BETHANY DIANE (DPT)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:DIANE
Last Name:ADLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 YELLOWSTONE ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8671
Mailing Address - Country:US
Mailing Address - Phone:913-980-7413
Mailing Address - Fax:
Practice Address - Street 1:1005 YELLOWSTONE ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8671
Practice Address - Country:US
Practice Address - Phone:913-980-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090169572251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics