Provider Demographics
NPI:1578797445
Name:BETHANY'S EQUINE AND AQUATIC THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:BETHANY'S EQUINE AND AQUATIC THERAPY SERVICES, INC
Other - Org Name:BEATS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:404-644-3917
Mailing Address - Street 1:1704 WINSTON CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-3573
Mailing Address - Country:US
Mailing Address - Phone:404-644-3917
Mailing Address - Fax:678-494-6616
Practice Address - Street 1:75 RED GATE TERRACE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115
Practice Address - Country:US
Practice Address - Phone:404-644-3917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006906261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy