Provider Demographics
NPI:1245837079
Name:CODREAN, BETHANY JOY (PT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:CODREAN
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 1:1794 N LAPEER RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-7664
Mailing Address - Country:US
Mailing Address - Phone:810-664-3000
Mailing Address - Fax:810-664-9775
Practice Address - Street 1:1794 N LAPEER RD STE C
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-7664
Practice Address - Country:US
Practice Address - Phone:810-664-3000
Practice Address - Fax:810-664-9775
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist