Provider Demographics
NPI:1336417047
Name:NEWBERRY, BETHANY RUTH (PTA, MT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:RUTH
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:PTA, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N HIGHWAY 27
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2447
Mailing Address - Country:US
Mailing Address - Phone:407-883-4151
Mailing Address - Fax:
Practice Address - Street 1:301 N HIGHWAY 27
Practice Address - Street 2:SUITE F
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2447
Practice Address - Country:US
Practice Address - Phone:407-883-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21220225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant