Provider Demographics
NPI:1972113769
Name:PIRTLE, BETHANY (DPT, PT, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:PIRTLE
Suffix:
Gender:F
Credentials:DPT, PT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 CHICHESTER AVE APT M06
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3220
Mailing Address - Country:US
Mailing Address - Phone:717-712-3463
Mailing Address - Fax:
Practice Address - Street 1:801 N BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4624
Practice Address - Country:US
Practice Address - Phone:302-654-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PART0066072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer