Provider Demographics
NPI:1245823814
Name:LENNON, BETHANY HASH (PT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:HASH
Last Name:LENNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:SUE
Other - Last Name:HASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1607 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-9768
Mailing Address - Country:US
Mailing Address - Phone:409-354-8086
Mailing Address - Fax:
Practice Address - Street 1:1607 LANTANA DR
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-9768
Practice Address - Country:US
Practice Address - Phone:409-354-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist