Provider Demographics
NPI:1720419070
Name:BRANN, BETHANIE ANNE (ATC)
Entity Type:Individual
Prefix:MS
First Name:BETHANIE
Middle Name:ANNE
Last Name:BRANN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WOLF RD UNIT 523
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1935
Mailing Address - Country:US
Mailing Address - Phone:207-512-0608
Mailing Address - Fax:
Practice Address - Street 1:42 WOLF RD UNIT 523
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1935
Practice Address - Country:US
Practice Address - Phone:207-512-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer