Provider Demographics
NPI:1669164356
Name:KETTERER, BETHANY BRIANNE (DPT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:BRIANNE
Last Name:KETTERER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CURTIS PARKWAY NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701
Mailing Address - Country:US
Mailing Address - Phone:706-529-3025
Mailing Address - Fax:706-383-6578
Practice Address - Street 1:215 CURTIS PARKWAY NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701
Practice Address - Country:US
Practice Address - Phone:706-529-3025
Practice Address - Fax:706-383-6578
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic