Provider Demographics
NPI:1548829203
Name:TURNER, BETHANY (PTA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LANEVIEW CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-9417
Mailing Address - Country:US
Mailing Address - Phone:731-819-0068
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:102 S TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:TN
Practice Address - Zip Code:38369-9728
Practice Address - Country:US
Practice Address - Phone:731-819-0068
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4403225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant