Healthcare Provider Details

I. General information

NPI: 1801377346
Provider Name (Legal Business Name): BETHANY GARRISON LAT, ATC, CES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 OHANLON DR
VAN ALSTYNE TX
75495-2959
US

IV. Provider business mailing address

221 OHANLON DR
VAN ALSTYNE TX
75495-2959
US

V. Phone/Fax

Practice location:
  • Phone: 214-592-5925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: