Provider Demographics
NPI:1144527920
Name:CARROLL, BETHANY (LMT, CMT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6880 W 91ST CT
Mailing Address - Street 2:#1-201
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4875
Mailing Address - Country:US
Mailing Address - Phone:720-244-2677
Mailing Address - Fax:
Practice Address - Street 1:8410 WADSWORTH BLVD
Practice Address - Street 2:UNIT I
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0917
Practice Address - Country:US
Practice Address - Phone:720-244-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10291225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist