Healthcare Provider Details

I. General information

NPI: 1225960263
Provider Name (Legal Business Name): BETHANY NICOLLE MATHIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11806 E 57TH TER
KANSAS CITY MO
64133-3522
US

IV. Provider business mailing address

11806 E 57TH TER
KANSAS CITY MO
64133-3522
US

V. Phone/Fax

Practice location:
  • Phone: 816-820-2756
  • Fax:
Mailing address:
  • Phone: 816-820-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2026021914
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: