Provider Demographics
NPI:1700265386
Name:EASTERLY, BETHANN
Entity Type:Individual
Prefix:
First Name:BETHANN
Middle Name:
Last Name:EASTERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WHITE BRIDGE RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1497
Mailing Address - Country:US
Mailing Address - Phone:615-354-1700
Mailing Address - Fax:
Practice Address - Street 1:95 WHITE BRIDGE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1497
Practice Address - Country:US
Practice Address - Phone:615-354-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6362225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist