Provider Demographics
NPI:1740046887
Name:EGGENBERGER, BETHANY CRYSTAL
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:CRYSTAL
Last Name:EGGENBERGER
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 1:1805 N STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-9421
Mailing Address - Country:US
Mailing Address - Phone:471-733-5205
Mailing Address - Fax:816-987-3131
Practice Address - Street 1:1805 N STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-9421
Practice Address - Country:US
Practice Address - Phone:816-540-8932
Practice Address - Fax:816-540-8937
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014034300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty