Healthcare Provider Details

I. General information

NPI: 1326855982
Provider Name (Legal Business Name): BETHANY JOY ULRICH ATC, LAT, DSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MAIN ST
SPRING ARBOR MI
49283-9701
US

IV. Provider business mailing address

120 E MAIN ST
SPRING ARBOR MI
49283-9701
US

V. Phone/Fax

Practice location:
  • Phone: 517-315-6562
  • Fax:
Mailing address:
  • Phone: 517-315-6562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601000796
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: