Provider Demographics
NPI:1861933814
Name:HISER, BETHANY (LMP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:HISER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SW 112TH ST
Mailing Address - Street 2:APT D306
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-4328
Mailing Address - Country:US
Mailing Address - Phone:206-250-0525
Mailing Address - Fax:
Practice Address - Street 1:130 SW 112TH ST
Practice Address - Street 2:APT D306
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-4328
Practice Address - Country:US
Practice Address - Phone:206-250-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60483746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist