Provider Demographics
NPI:1356692982
Name:KLOSTER, BETHANY LYNN (ATC, LAT, LMT)
Entity type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:LYNN
Last Name:KLOSTER
Suffix:
Gender:F
Credentials:ATC, LAT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 WEDNESDAY ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4335
Mailing Address - Country:US
Mailing Address - Phone:850-385-5113
Mailing Address - Fax:850-385-5601
Practice Address - Street 1:2309 WEDNESDAY ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4335
Practice Address - Country:US
Practice Address - Phone:850-385-5113
Practice Address - Fax:850-385-5601
Is Sole Proprietor?:No
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 31312255A2300X
FLMA 64511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer