Provider Demographics
NPI:1245655398
Name:DRUVENGA, BETHANY GRACE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:GRACE
Last Name:DRUVENGA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 HUDGINS FARM CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4191
Mailing Address - Country:US
Mailing Address - Phone:712-260-0671
Mailing Address - Fax:
Practice Address - Street 1:1301 COLLEGE AVE # 103
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5300
Practice Address - Country:US
Practice Address - Phone:540-654-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260018022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer