Provider Demographics
NPI:1760862577
Name:PIERCE, BETINA (DPT)
Entity Type:Individual
Prefix:
First Name:BETINA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9860 FAIRFAX BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1702
Mailing Address - Country:US
Mailing Address - Phone:703-383-1616
Mailing Address - Fax:703-383-1166
Practice Address - Street 1:7401 RIVERSIDE PKWY UNIT 219
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5057
Practice Address - Country:US
Practice Address - Phone:918-216-9303
Practice Address - Fax:539-202-5007
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3127225100000X
OKCP021773T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist