Provider Demographics
NPI:1033585062
Name:BELL, BETHANY L (DPT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:BELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:L
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD # SITE300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1930
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1600 E BELTLINE AVE NE STE 301
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7024
Practice Address - Country:US
Practice Address - Phone:616-818-0586
Practice Address - Fax:616-818-0587
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027115225100000X
MI5501303281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist