Provider Demographics
NPI:1184390726
Name:BARTOS, BETHANY M (LMT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:BARTOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 RUDDIMAN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2736
Mailing Address - Country:US
Mailing Address - Phone:616-329-2913
Mailing Address - Fax:
Practice Address - Street 1:428 RUDDIMAN DR
Practice Address - Street 2:
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-2736
Practice Address - Country:US
Practice Address - Phone:616-329-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501009775225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist