Healthcare Provider Details

I. General information

NPI: 1144257197
Provider Name (Legal Business Name): BETHANY LUNDIE ROULAND P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805-806 FLORAL VALE BOULEVARD
YARDLEY PA
19067
US

IV. Provider business mailing address

5400 BENSALEM BLVD
BENSALEM PA
19020-4016
US

V. Phone/Fax

Practice location:
  • Phone: 215-968-4901
  • Fax: 215-968-9718
Mailing address:
  • Phone: 215-638-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT001919E
License Number StatePA

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: