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General NPI Number Information
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NPI Number | 1205654720
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Entity Type | Individual
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Provider Name | BETHANY LAWSON PTA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1206 N MAIN ST
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City | MOUNTAIN GROVE
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State | MO
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Zip | 65711-1025
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Country | US
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Telephone | 417-926-5699
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Fax | 417-926-5703
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Provider Business Mailing Address
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Address Line | 833 TURNBO RD
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City | MARSHFIELD
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State | MO
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Zip | 65706-9070
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Country | US
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Telephone | 417-241-0185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2019027359
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License Number State | MO
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