Provider Demographics
NPI:1831309632
Name:HORTON, BETHANY ANN (DPT, ATC, CLT)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ANN
Last Name:HORTON
Suffix:
Gender:F
Credentials:DPT, ATC, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEATHERHOLT DR
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-9306
Mailing Address - Country:US
Mailing Address - Phone:304-390-5705
Mailing Address - Fax:
Practice Address - Street 1:100 WEATHERHOLT DR
Practice Address - Street 2:
Practice Address - City:ONA
Practice Address - State:WV
Practice Address - Zip Code:25545-9306
Practice Address - Country:US
Practice Address - Phone:304-390-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002647225100000X
PART0041112255A2300X
PAPT018962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer