Provider Demographics
NPI:1649586199
Name:ARTHUR, BETHANY MICHELLE (BETHANY ARTHUR PTA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MICHELLE
Last Name:ARTHUR
Suffix:
Gender:F
Credentials:BETHANY ARTHUR PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2000
Mailing Address - Country:US
Mailing Address - Phone:317-571-1250
Mailing Address - Fax:317-571-1290
Practice Address - Street 1:8905 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2000
Practice Address - Country:US
Practice Address - Phone:317-571-1250
Practice Address - Fax:317-571-1290
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003805A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant