Provider Demographics
NPI:1316031909
Name:FROBOESE, BETHANY SUZANNE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:SUZANNE
Last Name:FROBOESE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:SUZANNE
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2319 RUDOLPHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2228
Mailing Address - Country:US
Mailing Address - Phone:931-920-4333
Mailing Address - Fax:931-920-4346
Practice Address - Street 1:2319 RUDOLPHTOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2228
Practice Address - Country:US
Practice Address - Phone:931-920-4333
Practice Address - Fax:931-920-4346
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN07566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36473521Medicaid
TN36473521Medicare PIN