Provider Demographics
NPI:1538989538
Name:KLASSY, BETHANY ERIN
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ERIN
Last Name:KLASSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45733 W WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-7086
Mailing Address - Country:US
Mailing Address - Phone:480-392-5152
Mailing Address - Fax:
Practice Address - Street 1:45733 W WINDMILL DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-7086
Practice Address - Country:US
Practice Address - Phone:480-392-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-29746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty