Provider Demographics
NPI:1558804005
Name:MACEDO, BETHANY (ATC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MACEDO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:LEMIEUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:13 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3606
Mailing Address - Country:US
Mailing Address - Phone:774-328-1590
Mailing Address - Fax:
Practice Address - Street 1:480 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3729
Practice Address - Country:US
Practice Address - Phone:774-328-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3030207PS0010X, 2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program