Provider Demographics
NPI:1679026280
Name:PEREZ, BETHANY (ATC)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:BURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3621 TAFT PARK
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3621 TAFT PARK
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4559
Practice Address - Country:US
Practice Address - Phone:504-376-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH. 2002852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer