Provider Demographics
NPI:1306362140
Name:BARON, BETHANY RAE (PT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:RAE
Last Name:BARON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:RAE
Other - Last Name:KADRLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4200 DAHLBERG DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4841
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:
Practice Address - Street 1:3111 124TH AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4573
Practice Address - Country:US
Practice Address - Phone:763-427-7300
Practice Address - Fax:763-427-2802
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist