Provider Demographics
NPI:1720552540
Name:DENARDO, BETHANY A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:A
Last Name:DENARDO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 GAR HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3924
Mailing Address - Country:US
Mailing Address - Phone:508-962-6521
Mailing Address - Fax:508-379-1231
Practice Address - Street 1:2201 GAR HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3924
Practice Address - Country:US
Practice Address - Phone:508-962-6521
Practice Address - Fax:508-379-1231
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI806225100000X
MA4732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist