Provider Demographics
NPI:1801291448
Name:SMITH, BETHANY PEARL (PT)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:PEARL
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 IRMC DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3674
Mailing Address - Country:US
Mailing Address - Phone:724-465-2676
Mailing Address - Fax:724-465-0193
Practice Address - Street 1:120 IRMC DR
Practice Address - Street 2:SUITE 160
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3674
Practice Address - Country:US
Practice Address - Phone:724-465-2676
Practice Address - Fax:724-465-0193
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist