Provider Demographics
NPI:1205654720
Name:LAWSON, BETHANY (PTA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 TURNBO RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-9070
Mailing Address - Country:US
Mailing Address - Phone:417-241-0185
Mailing Address - Fax:
Practice Address - Street 1:1206 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1025
Practice Address - Country:US
Practice Address - Phone:417-926-5699
Practice Address - Fax:417-926-5703
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019027359225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant