Provider Demographics
NPI:1205919859
Name:DAVENPORT, BETHANY ANNE (PT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANNE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 WEATHERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9651
Mailing Address - Country:US
Mailing Address - Phone:731-686-8373
Mailing Address - Fax:731-686-2154
Practice Address - Street 1:8017 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358
Practice Address - Country:US
Practice Address - Phone:731-686-8373
Practice Address - Fax:731-686-2154
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist