Provider Demographics
NPI:1770163412
Name:WURST, BETHANY RENEE (LMT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:RENEE
Last Name:WURST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 BRANSON HILLS PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-4188
Mailing Address - Country:US
Mailing Address - Phone:417-338-9355
Mailing Address - Fax:417-708-9797
Practice Address - Street 1:1232 BRANSON HILLS PKWY STE 202
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-4188
Practice Address - Country:US
Practice Address - Phone:417-338-9355
Practice Address - Fax:417-708-9797
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019041532225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist