Healthcare Provider Details

I. General information

NPI: 1043141591
Provider Name (Legal Business Name): BETHANY NELSON PT DPT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 N HIGHLAND AVE STE B
MURFREESBORO TN
37130-2443
US

IV. Provider business mailing address

1024 N HIGHLAND AVE STE B
MURFREESBORO TN
37130-2443
US

V. Phone/Fax

Practice location:
  • Phone: 678-449-0199
  • Fax: 678-449-0199
Mailing address:
  • Phone: 678-449-0199
  • Fax: 678-449-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LINSEY PORTER
Title or Position: MANAGER OF THERAPY OPERATIONS
Credential: COTA-L
Phone: 219-242-4809