Provider Demographics
NPI:1740566165
Name:GEISER, BETHANY (PTA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:GEISER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-2611
Mailing Address - Country:US
Mailing Address - Phone:302-629-4587
Mailing Address - Fax:
Practice Address - Street 1:309 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-2611
Practice Address - Country:US
Practice Address - Phone:302-629-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist