Provider Demographics
NPI:1689897324
Name:ST.HILAIRE, BETHANY L
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:L
Last Name:ST.HILAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:15 WEST STREET
Mailing Address - City:BRASHER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13613-0004
Mailing Address - Country:US
Mailing Address - Phone:315-261-5460
Mailing Address - Fax:
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:CLARKSON HALL
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2148
Practice Address - Country:US
Practice Address - Phone:315-261-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003379-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant