Provider Demographics
NPI:1770394496
Name:BETHKA, ROBIN ELAINE-ANN (PTA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:ELAINE-ANN
Last Name:BETHKA
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 1:5219 W PIERSON RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2411
Mailing Address - Country:US
Mailing Address - Phone:810-262-7896
Mailing Address - Fax:810-230-3366
Practice Address - Street 1:5219 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2411
Practice Address - Country:US
Practice Address - Phone:810-262-7896
Practice Address - Fax:810-230-3366
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004786225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant