Provider Demographics
NPI:1790015915
Name:BEIGH, BETHANY (LMP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:BEIGH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6610 NE 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3701
Mailing Address - Country:US
Mailing Address - Phone:360-910-7686
Mailing Address - Fax:360-885-1394
Practice Address - Street 1:615 SE CHKALOV DR
Practice Address - Street 2:SUITE 7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5279
Practice Address - Country:US
Practice Address - Phone:360-885-1767
Practice Address - Fax:360-885-1394
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60129900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist