Provider Demographics
NPI:1568113199
Name:TRANG, BETHANY DIGIOVANNI (DPT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:DIGIOVANNI
Last Name:TRANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:DIGIOVANNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11800 XEON BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2061
Mailing Address - Country:US
Mailing Address - Phone:612-240-1350
Mailing Address - Fax:
Practice Address - Street 1:11800 XEON BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-2061
Practice Address - Country:US
Practice Address - Phone:612-240-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist