Healthcare Provider Details

I. General information

NPI: 1366573933
Provider Name (Legal Business Name): CHRISTOPHER S BETHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 S GOVERNORS AVE
DOVER DE
19904-4802
US

IV. Provider business mailing address

1812 MARSH RD STORE 505
WILMINGTON DE
19810-4581
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-0100
  • Fax: 302-677-0267
Mailing address:
  • Phone: 302-793-1800
  • Fax: 302-793-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0000933
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberJ3-0000066
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberJI-0000933
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: