Healthcare Provider Details

I. General information

NPI: 1083770051
Provider Name (Legal Business Name): BARBARA C BETHEA MA, PT-R, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N PORTLAND AVE ROOM B6
BROOKLYN NY
11205-2005
US

IV. Provider business mailing address

23111 125TH AVE
LAURELTON NY
11413-1302
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-7879
  • Fax: 718-260-4801
Mailing address:
  • Phone: 718-978-4663
  • Fax: 718-527-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number000922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: