Provider Demographics
NPI:1659772283
Name:AHO, BETHANY LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LYNN
Last Name:AHO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 ARBORWAY APT 10
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1954
Mailing Address - Country:US
Mailing Address - Phone:906-281-6617
Mailing Address - Fax:
Practice Address - Street 1:906 ARBORWAY APT 10
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1954
Practice Address - Country:US
Practice Address - Phone:906-281-6617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004324225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant