Provider Demographics
NPI:1396611091
Name:ETHRIDGE, BEATRIZ
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:ETHRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:INMACULADA
Other - Middle Name:BEATRIZ
Other - Last Name:ETHRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT
Mailing Address - Street 1:1502 MIDLANE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3240
Mailing Address - Country:US
Mailing Address - Phone:956-495-0402
Mailing Address - Fax:956-622-0333
Practice Address - Street 1:1502 MIDLANE DR STE 110
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3240
Practice Address - Country:US
Practice Address - Phone:956-495-0402
Practice Address - Fax:956-622-0333
Is Sole Proprietor?:No
Enumeration Date:2025-10-11
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT132358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist