Provider Demographics
NPI:1912402058
Name:YODER, BETHANY (PT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:BONTRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:346 PARKVIEW RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-3807
Mailing Address - Country:US
Mailing Address - Phone:540-674-4193
Mailing Address - Fax:540-674-6734
Practice Address - Street 1:346 PARKVIEW RD NE STE B
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-3807
Practice Address - Country:US
Practice Address - Phone:540-674-4193
Practice Address - Fax:540-674-6734
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist